KARIUKI: NHIF's strides towards implementing Universal Health Coverage

Government sponsoring poor households by paying their NHIF annual premiums.

In Summary

• At the onset of the national UHC scale up, the Government has committed itself to sponsoring the poor and vulnerable households by paying their NHIF annual premiums.

• Meanwhile, amendment of the NHIF Act is ongoing to ensure that the necessary legal framework is in place for the attainment of UHC. 

Kitui Governor Charity Ngilu when she registered for the Kitui County Universal Health coverage program.
Kitui Governor Charity Ngilu when she registered for the Kitui County Universal Health coverage program.

The Government of Kenya made the promise in 2018 that Kenya will be in a state of Universal Health Coverage (UHC) by the year 2022.

This was among His Excellency the President's Big Four Agenda. UHC means that all citizens can access promotive, preventive, curative, rehabilitative and palliative health care services they need and of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship (WHO).

The Sustainable Development Goals (SDG), target 3.8 focuses on the attainment of Universal Health Coverage (UHC) by assuring financial protection and provision of quality essential health services.

NHIF is tasked to drive the UHC agenda under the guidance of the Ministry of Health (MoH).

The goal is that by the end of 2022, Kenyans can access affordable health care services.

This started with the UHC Pilot that was done for one year from December 2018 to December 2019 in four counties namely Isiolo, Nyeri, Machakos and Kisumu.

The pilot was implemented on an input financing model in which the hospitals were given all inputs needed in terms of health products and technologies, and citizens of the four pilot counties were then to access healthcare services free of any charge. A lot was learnt from the pilot that has informed the National UHC scale-up in all the 47 Counties.

On the immediate phase upon completion of the pilot, the Government engaged in National UHC Scale up through the Inter-Governmental Participatory Agreements (IPA) signed between the National Government and the County Governments expanding UHC implementation beyond the four Counties still on an input financing model.

During the pilot, the Cabinet Secretary MoH appointed the Health Financing Reforms Expert Panel (HEFREP) for the transformation and repositioning of NHIF towards the attainment of UHC by the Year 2022.

The panel made various recommendations including National UHC Scale-up on an output financing model also referred to as Result-Based Financing Model anchored on NHIF, the national social health insurer.

In the output financing model, NHIF beneficiaries can receive treatment in hospitals empanelled with NHIF and the healthcare providers will then lodge claims at NHIF for reimbursement of expenses incurred to treat NHIF beneficiaries.

At the onset of the national UHC scale up, the Government has committed itself to sponsoring the poor and vulnerable households by paying their NHIF annual premiums.

Based on the National Housing and Population Census 2019, there are 5.1 million poor and vulnerable Kenyan households that the Government has committed to sponsoring with NHIF.

The Government has commenced the sponsorship with 1 million households to be covered with NHIF in the first year of scale-up.

Currently, NHIF membership is 13.8 million principal members and 17.9 dependants translating to total coverage of 31.7 million Kenyans which is approximately 66 per cent of the Kenyan population.  

However only approximately 40 per cent of these are actively contributing, the rest having defaulted in their monthly NHIF contributions.

Meanwhile, amendment of the NHIF Act is ongoing to ensure that the necessary legal framework is in place for the attainment of UHC.

Among the recommended amendments is mandating all Kenyan residents to enrol and make contributions to NHIF for their health insurance coverage. Kenya has benchmarked with countries like Thailand which have achieved UHC through a health insurance model which is more sustainable than an input financing model. 

The NHIF (Amendment) Bill, 2021 is undergoing the legislation process at the National Assembly and The Senate and is now currently on the last legislation steps at the National Assembly following recommendations by The Senate.

The amendments are suitable for the country and Kenya towards UHC and will ensure every Kenyan in the informal and formal sectors has enrolled with NHIF.

Although many Kenyans in the informal sector can afford NHIF premiums most of them have not enrolled due to the voluntary nature of the informal sector membership to NHIF.

For instance, a boda-boda person, in the urban areas makes on average of Sh1,200 to Sh1,500 per day after expenses yet NHIF premium translates to Sh17 per day for a household cover.

However, most boda-boda riders have not enrolled with NHIF and in case they are hurt in the line of duty, they conduct funds drive to cater for their medical bills.

Upon passing of the Bill the supporting regulations will be put in place to create mechanisms for the informal sector members to make their NHIF contributions in the most convenient way as part of their routine processes such as renewal of driving licenses, business permits etc to ensure they do not default in their monthly NHIF obligations.

Health insurance works on the pooling of resources, thus the need for all Kenyans to contribute to NHIF to create an adequate financial base that can sustain a comprehensive benefits package for all Kenyans.

With all Kenyans enrolling with NHIF, fundraising for medical bills; a practice that has become quite unpopular in Kenya will become an outdated practice.

NHIF has had the Supa Cover, which is a comprehensive benefits package comprising of ten unique benefits namely; Outpatient Cover, Inpatient Cover, Maternity Cover, Radiology Cover (MRI & CT Scan), Surgical Package, Renal Dialysis, Oncology Cover, Drug & substance Abuse Rehabilitation, Road Ambulance Evacuation and Overseas Treatment that assures the members of benefits up to Sh500,000 in a single treatment case from the premium of just Sh6,000 per annum.

During the UHC Pilot, the government had commissioned the UHC Health Benefits Package Advisory Panel (HBAP) to recommend a suitable UHC Benefits Package.

Upon the decision for NHIF to drive UHC on an output financing model, harmonization was done between the HBAP recommended package and the NHIF Supa Cover benefits package.

The harmonized UHC benefits package is now ready for implementation.

It is expected that as more Kenyans enrol with NHIF, benefits can be cost less because of the mass production of healthcare services.

Healthcare providers will therefore be able to realize adequate mark-ups resulting from economies of scale due to mass production of healthcare services.

It will, therefore, be a win-win-win situation for the beneficiaries who will all be covered, healthcare providers who will still realize their mark-ups and NHIF who will be able to offer an expanded benefits package to Kenyans.

The overall goal is sustainability and more coverage to ensure no one is left behind. 

In the National UHC Scale-up driven by NHIF, both Government and non-government healthcare providers namely private and faith-based healthcare providers will be contracted to UHC benefits provided they attain the required threshold.

NHIF currently has 7,666 empanelled healthcare providers which are currently undergoing recontracting to align them to the UHC Agenda.

NHIF considers healthcare providers which have been accredited through the MoH and which possess the requisite licenses and certificates of registration for empanelment.

Kenya is on the right track of attainment of UHC and NHIF has undergone a transformation which has repositioned as the most suitable vehicle to drive UHC in Kenya.

Wambugu Kariuki is the Head, Beneficiary Management National Hospital Insurance Fund