•The commitment to healthcare is anchored in the Big Four Agenda, which draws support from the Constitution of Kenya 2010 and the long-term development blueprints, Sustainable Development Goals (SDGs), and Vision 2030.
•The government identified the National Health Insurance Fund (NHIF) as an institution to accelerate the attainment of UHC and has reformed it as a strategic purchaser of healthcare.
Image: FILE
As the current Government prepares to leave office, credit goes to H.E President for prioritising Universal Health Coverage for Kenyans to access quality healthcare services without suffering financial difficulties.
While launching the National UHC Scale-up in Mombasa County on February 7, 2022, the President affirmed his government’s commitment to “eradicating the ‘poverty of dignity’ by ensuring that no Kenyan is forced to choose between medical bills and other essential needs.”
The commitment to healthcare is anchored in the Big Four Agenda, which draws support from the Constitution of Kenya 2010 and the long-term development blueprints, Sustainable Development Goals (SDGs), and Vision 2030.
The government identified the National Health Insurance Fund (NHIF) as an institution to accelerate the attainment of UHC and has reformed it as a strategic purchaser of healthcare.
Key reforms and transformations witnessed in the last 10 years as the country journeys towards universal coverage are many. To mention a few, UHC calls for 100% health insurance coverage for the population where those who can afford to pay, do so and the Government identifies and support those who cannot.
There is a marked increase in the population covered from 3.8 million in 2013 to 15.5 million principal members in 2022. This means over 40 million Kenyans have been protected from poverty due to high out of pocket expenditure on healthcare services.
President Kenyatta’s government has been keen on cushioning indigent and vulnerable households from sinking deeper into poverty due to medical costs. It has sponsored 1.2 million indigents and vulnerable households out of the 5.1 million identified by the Kenya National Bureau of Statistics in the 2019 census report. Plans are in place to expand coverage to the remaining indigent households.
The growth in membership has increased the revenue base of the Fund. The institution posted revenue growth from Kshs 13billion in 2013 to Kshs 80billion in 2022 and paid out claims of Kshs. 74.3billion, an increase of over Kes50billion since 2013.
To secure the financial stability and sustainability of the Fund, the Government has over the years strengthened the legal framework to support NHIF operations through the amendment of the NHIF Act. The 1998 amendment allowed NHIF to expand the benefit packages, and coverage to poor households and offer enhanced cover to government institutions such as the civil servants, police, prisons officers, and retired public servants.
The President assented to the NHIF amendment Bill 2021 on January 10, 2022, setting the stage for drafting regulations to implement the Act. The NHIF Act 2022 implements sponsored programs funded by the Government targeting the indigents and vulnerable households in addition to the existing free maternity cover (Linda mama) for all women, health insurance subsidy program for orphans, vulnerable children, older persons, and persons living with severe disabilities.
The new Act enforces mandatory contributions. The gains have, however, been derailed by a court case challenging the implementation of the regulations. NHIF suffers from a high attrition rate in the informal sector due to adverse selection and a lack of enforcement mechanisms for compliance. Only 15% of the 8.1million informal sector members in FY2021/22 were active. Meaning the sponsored households have a higher retention rate at 1.3 million members, while the informal sector has 1.2 million active members.
Implementation of the regulations would cure the problem that has been persistent over the years due to the voluntary nature of the informal sector membership. The active members contribute because they need sustained treatment, while others join in only when they have a medical need and exit soon after.
Another key milestone is digital transformation to ease the cost of doing business for the members and stakeholders, handle the big data, deter fraud, abuse, and wastage, and improve customer experience.
President Uhuru Kenyatta launched the biometric registration and identification exercise and the deployment of the electronic claim (E-Claim) management system in all levels IV and above hospitals on October 31, 2020.
The self-care platform on mobile and web applications brings services closer to people while, a 24- hour call centre handles over 3,000, 10,000 emails and 50,000 SMS a month.
In 2013, NHIF offered inpatient services. In 2015, the Government reviewed the contribution rates allowing NHIF to enhance the benefit packages. The benefits include outpatient services, renal dialysis, cancer care, diagnostics, surgical, road evacuation, maternity, drug and substance abuse, and overseas treatment packages.
The Fund has further reviewed and expanded the benefit packages in 2022 based on the burden of disease, the population needs, and affordability. The highlights of the benefit packages include standardization of the amount paid to all hospital levels, outpatient services consisting of management of non-communicable diseases (NCDs), expansion of the cancer care cover to include bone scan and radionuclide therapy and increased complex chemotherapy sessions from four to six.
Further, the Surgical benefit package increased the surgeries from 292 to 549 while introducing interventional radiology. The screening and diagnostic services to enhance early detection for better health outcomes expanded to include mammography, fluoroscopy, ECHOs, EEGs, and specialized ultrasound imaging. The mental and behavior health package was also enhanced.
To enhance access to the services, the healthcare providers have increased since 2013 from 1,432 to 7,800 in 2022. The public facilities comprise 80% of the facilities. In July 2022, NHIF rolled out the contracting cycle 2022/24 with two types of contracts: comprehensive contract allows beneficiaries to access services on a walk-in – walk-out basis, and non-comprehensive on co-payment. 89% of the hospitals agreed to sign the comprehensive contract.
The milestones mentioned are the tip of the iceberg. More was achieved in the health sector during President Kenyatta's tenure. Moving forward, NHIF will continue to live its mission statement of enhancing equitable and sustainable health, caring about the community's wellbeing, and cushioning them from financial hardship. To accomplish these, NHIF commits itself to observe the highest ideals of finding a better way to do things, making a difference, winning together, and doing the right thing as it implements its strategies.
The author is the CEO of the National Health Insurance Fund (NHIF)
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