Kenya aims to expand social health protection to currently uncovered populations
The Government of Kenya has committed to reach universal health coverage. Kenya has a complex and devolved health financing system. The National Health Insurance Fund (NHIF) is the sole social health insurance agency in Kenya and is meant to provide social health insurance to all Kenyans. Unmet need is high with approximately one fourth of the population is covered (DHS, 2022), and active membership (those who are current in their contributions in the last 12 months) is lower still.
The NHIF was created initially to cover workers in the formal economy and civil servants to meet the cost of inpatient treatment for its contributing members and their immediate family members (add link here for NIHF act when posted). In recent years, NHIF has reviewed its portfolio of activities to expand its services and coverage to workers in the informal economy (with their families) and vulnerable groups. Voluntary members make a contribution at a monthly rate of KES 500 (4 USD) while those in formal employment contribute based on a graduated scale as per their income with the least being KES150 and a maximum of KES1700. Due to the voluntary enrolment mechanism, all people residing in Kenya who have an ID and a SIM card can enroll into NHIF, including migrant workers. In 2020, 3.6 million members from the informal sector were voluntarily insured, however, only 1.5 of the 3.6 million were active members. Poor and vulnerable households identified through cash-benefits are enrolled through Government subsidies and partners, such as UNHCR, subsidize vulnerable refugees.
NHIF is facing the challenge of voluntary members joining the fund when knowing that they are in need of a medical procedure (e.g. surgery) and then dropping out again. There have been ongoing discussions on establishing different social economic categories for different levels of contributions particularly in the informal economy. However, in order to introduce such a system, a complex socio-economic assessment mechanism would have to be set-up to assess means of contributing and capacity to pay among the informal economy and rural workers. Further measures have also been introduced to enhance sustainability of NHIF for instance paying premiums one year upfront before voluntary contributors can access services, which has further exacerbated the inadequate coverage of the informal and rural economy workers.
Expansion of Coverage with Limited Fiscal Space
NHIF membership has recently become mandatory for all Kenyans who have attained the age of 18 years and are working in the formal sector. The challenge that Kenya is now facing is how to enforce this mandatory nature of NHIF. Current plans of the Government (insert HF strategy here when posted) range from increasing the number of households that are currently covered by the Government (poor households) from 1.5 million to 5 million households, which would mean that around 40 percent of the population would be covered by NHIF through government subsidies. This would raise the question of identification of poor people as currently NHIF subsidies are linked to the Kenyan cash programs. Further, the contribution rates for fully subsidized members and workers in the informal economy need to be reviewed to ensure sustainability of the fund in the future.