Examining National Hospital Insurance Fund reforms in Kenya

Kemri Wellcome Trust , 2018

The Kenyan government has made a commitment to achieve Universal Health Coverage (UHC) by 2030. A key part of its UHC strategy is to expand coverage of the National Hospital Insurance Fund (NHIF), which currently covers approximately 15% of the population. In 2015, the NHIF introduced significant reforms aimed at enrolling more people and expanding the range of services that enrolled members have access to.

Kemri-Wellcome Trust have conducted in-depth qualitative research to examine the influence of these reforms on NHIF purchasing pratices. This brief presents the key findings of the research and provides recommendations for improving the impacts of the reforms in the future.

Key points

  • The new NHIF premium rates are unaffordable to informal sector workers, resulting in low coverage and attrition among this group.
  • The new benefit packages have led to different service entitlements for different patient groups, which may entrench inequalities in access to services.
  • Poor infrastructural capacity of contracted public healthcare providers and ineffective monitoring of quality by the NHIF, undermine access to quality services. Availability of services was parcticularly limited in rural areas.
  • Capitation payment rates for the general scheme are percieved by healthcare providers to be inadequate, and payment disbursements by the NHIF in general are often delayed. This resulted in undesirable practices including the introduction of out of pocket payments, unnecessary referrals or admissions to inpatient facilities, and under-treatment or rationing of services to patients.

Related resources

Policy brief: Examining multiple funding flows to public healthcare facilities in Kenya

Presentation: Nature and effects of multiple funding flows to public healthcare facilities: A case study from Nigeria

Resources from the Health Financing and Governance Knowledge Synthesis Workshop

RESYST Working Paper 7: A critical analysis of the purchasing arrangements in Kenya

Policy brief | Financing