There is a misconception about universal health coverage as a medical scheme where members are supposed to subscribe to access healthcare financing when seeking healthcare services.
While UHC has health financing, it encompasses other health services, including primary, preventive, promotive and palliative care, access to quality services in hospitals. Additionally, there are enough personnel to tend to patients, drugs availability, and individuals' ability to afford these services without sinking into poverty due to out-of-pocket expenditure.
The other misconception is that UHC is tied to the ruling government and will wind up as soon as its term is over. Quite the contrary, it is commendable that the government has created a conducive environment for UHC attainment by 2022.
UHC is a journey that started after Independence and will continue for generations to come. Furthermore, technological advancements, environmental shifts, political landscape changes, and the emergence of Covid-19 continue to affect the health industry.
In 2019, half the world’s population had limited access to essential health services (WHO). Additionally, approximately 100 million people globally and one million Kenyans are pushed into extreme poverty due to healthcare expenditure.
The government has thus prioritised UHC anchored in the Big Four agenda and supported by the 2010 Constitution, the SDGs and Vision 2030. These emphasise every citizen's right to the highest attainable healthcare services without suffering financial difficulties.
The government has implemented legal and institutional frameworks to ensure sustainability, including transforming and repositioning the National Hospital Insurance Fund as a critical vehicle under the Ministry of Health to scale up UHC as a strategic healthcare purchaser.
Initially, a pretest was done in four counties (Kisumu, Machakos, Nyeri and Isiolo) on an input financing model; selected based on the disease burden. Then, through the Ministry of Health, the government laid a strong UHC foundation by increasing human resources for health, purchasing basic medical equipment, essential medicines and commodities, and strengthening community health programmes.
The government changed tack on the UHC scale-up following lessons learnt from the pilot phase. The focus was on a more sustainable health insurance model while strengthening health systems. To ensure efficiency and equity in coverage, UHC scale-up was structured on an output-financing model (insurance) through NHIF, meaning all Kenyans must register as members for UHC attainment.
With a self-sustaining environment, members contribute to the Fund and access services in contracted healthcare facilities, and NHIF reimburses these hospitals. In turn, the hospitals use the finances to improve their facilities, therefore enhanced quality services.
The NHIF is undergoing reforms to meet the volumes of increased membership and revenue. The Fund is best positioned to provide health insurance to Kenyans due to its vast social health insurance experience for over 55 years. NHIF has well-established systems, a vast network of contracted healthcare providers, service points, self-care platforms and diversified benefits packages.
The NHIF Act (Amendment) Bill 2021 currently in Parliament for the legislation process is crucial for reforms recommended to change the institution. The Bill will ensure NHIF’s sustainability by increasing health insurance coverage through expanding sponsored health insurance coverage of vulnerable households and obligating those who can pay to do so. This will improve equitable access to quality health services and enhance financial risk protection for all Kenyans.
While the Amendment Bill has elicited much debate, it is a well-intentioned document that will ensure every Kenyan is protected from high spending costs in healthcare. The Bill’s proposals work in tandem with other reforms recommended to transform NHIF that support the expansion of healthcare providers networks.
To ensure service delivery efficiency and cost containment in its service points, NHIF has digitalised its processes by deploying an electronic claim management system at NHIF contracted healthcare facilities and launching biometric identification of members.
The government is targeting 1 million vulnerable households countrywide in phase one of UHC scale-up, thus approximately 4 million beneficiaries; therefore, 20 per cent of the total indigent household population of 5.1 million as per the KNBS 2019 Housing and Population Census. In addition, the government plans to gradually increase coverage of indigent households with a goal of 100 per cent coverage by June 2022.
The counties, constituencies, NGOs, and well-wishers have also identified and supported indigents. This demonstrates the will to attain UHC by 2022 if everyone makes monthly contributions for themselves or supports those who cannot pay. So let us live the UHC vision of leaving no one behind.
CEO, National Hospital Insurance Fund
