Kenya

Population Coverage: 2.7 million Year Launched: 1966 Membership : Full Member

Expanding benefits.

The National Hospital Insurance Fund is the primary provider of health insurance in Kenya with a mandate to enable all Kenyans to access quality and affordable health services.

The Context

NHIF was restructured by the repeal of the National Hospital Insurance Act (CAP 255) and the enactment of the National Hospital Insurance Fund Act No. 9 in 1998. This new law made the NHIF an autonomous parastatal, separating it from the direct control of the Ministry of Health. A Board of Directors governs the Fund with representatives from civil society, employers, and local governments. The Health Insurance Act of 1998 makes no distinction between formal and informal sector, and indicates that membership shall be mandatory for all Kenyans at least 18 years of age. In practice, however, while Kenya has achieved high levels of coverage of the formal sector, coverage of the informal sector has proved more challenging.

Key Reforms

In 1966 the MOH established the National Hospital Insurance Fund (NHIF) as a department, with the social principle that “the rich should support the poor, the healthy should support the sick, and the young should support the old.” NHIF provided insurance for salaried employees earning at least KES 1,000 per month. Members contributed KES 20 monthly in order to receive comprehensive in-patient benefits at affiliated hospitals.

In 1972, voluntary members were allowed to participate in the Insurance Fund, contributing a monthly KES 60 for in-patient coverage. In 1990 graduated scale for contributions based on wages was introduced, with a cap at KES 15,000 per month with monthly contributions ranging from KES 30 to KES 320.

In 1993 the MOH began working on a health reform plan employing decentralization as a guiding strategy. In 1994 the Kenya Health Policy Framework Paper (KHPFP) was published, aiming for “quality health care that is acceptable, affordable, and accessible to all” by 2010. The KHPFP was implemented through 2 five-year National Health Sector Strategic Plans (NHSSP), which worked to decentralize the health system by assigning more management activities to district level organizations and organizing a Sector Wide Approach (SWap) that brings together all stakeholders (the government, donors, NGOs) under a single budget, monitoring system, and coordinating function. The NHSSP also implemented the Kenya Essential Package for Health (KEPH), which shifted the health focus from vertical disease-specific to an emphasis on 6 stages of the human life cycle (cohorts).

In 2004 the National Social Health Insurance Fund (NSHIF) was proposed to achieve universal health coverage by imposing a social tax on the employed to subsidize health insurance for those who cannot pay. NSHIF was passed by Parliament in 2004, but due to a number of protests and questions about the structure, financing model and from both the private sector and the civil society the President returned it for debate and it was subsequently not passed. As a response, a 10/20 policy was implemented to lower outpatient expenses, involving a payment system through which primary health care provided at dispensaries and health centers is free for all citizens, except for a minimum registration fee of Kenya Shillings (KES) 10 at dispensaries and 20 at health centers (approximately USD 0.2 and 0.3).

Impact: Cross-Country Knowledge Sharing

Kenya participated in their first Joint Learning Network for Universal Health Coverage (JLN) Workshop in Mombasa, Kenya in June 2011. The workshop focused on sharing creative approaches and best practices on expanding coverage. After the workshop, Kenya became a full member of the JLN. Since joining three years ago, Kenya has actively participated in the Information Technology and Quality Initiatives. In addition, Kenya has shared best practices with Mali around mobile-based payment mechanisms and collaborated with Ghana’s National Health Insurance Scheme to develop a common e-claims form.

After learning about Kenya’s use of mobile telephony for registration of clients during the JLN workshop in Mombasa, Kenya, Mali has been exploring how to adapt Kenya’s approach to Mali’s context. In September 2013, Union Technique de la Mutualité Malienne (UTM) launched its mobile money application for premium payments for the Mutuelle.

In 2012, Ghana and Kenya began using OpenHDD to document the joint e-claims standard that they have developed, and to harmonize their data elements.