Achieving Universal Health Coverage (UHC) remains one of the key pillars of President Uhuru Kenyatta’s big four agenda, with several strategies being put in place by the government to ensure its achievement.
The National Health Insurance Fund (NHIF) has been chosen as the vehicle through which the population will access quality health services without suffering financial hardship.
The decision follows the pilot project in 2018/19 in four counties which was implemented on an input financing model, where public facilities were supported by technologies, human capital, equipment and products allowing the public free access to services.
Scale-up was implemented on an insurance model that proved to be more sustainable while still focusing on strengthening health systems. To ensure the sustainability and cost containment of the NHIF, the state initiated a series of reforms that would ensure the transition and position the Fund as a strategic purchaser of health services.
Reforms include digitizing NHIF processes, restructuring and realigning the structure, benefit design and amending the NHIF Act.
With all of these plans and initiatives on UHC, a number of strategies have been put in place to ensure the dream is realized and sustained.
Key to these strategies is the inclusion of all Kenyans as members of the NHIF. The current membership consists of 14.3 million primary members and 18.6 dependents, totaling 32.9 million beneficiaries. This represents 69% of the total population of 47 million Kenyans.
However, only 44.6% (6.3 million members) are active. Active people mostly need sustained treatment, as others only arrive because they have a medical need and give up once met. This trend has strained NHIF resources and is not sustainable.
The amended NHIF Act provides that all Kenyans over the age of 18 must be registered as members of the NHIF. The law has provided for mandatory contributions for all who can afford to pay for their health insurance while the state will identify and support indigent and vulnerable households.
The second strategy is the purchase of health services. The amended law gives the NHIF the ability to be creative in terms of engagement for strategic purchasing of health services. With the change of name, from National Hospital Insurance Fund to National Health Insurance Fund, the Fund can now contract different healthcare providers in addition to hospitals.
They include laboratories, consultants, pharmacies, hospices and medical professionals. Plans are at an advanced stage to introduce a pharmacy benefits package that aims to reduce the cost of drugs and make them accessible at contracted facilities.
Supply-side financing also remains crucial. The success of UHC will mean that beneficiaries will have access to the services they need, including pharmaceutical and non-pharmaceutical products, when they see health care providers.
A long-term strategy to control and reduce costs related particularly to non-communicable diseases is to partner with pharmaceutical manufacturers and distributors to ensure efficient and cost-effective strategic purchasing for NHIF beneficiaries.
Engagement with counties is also essential. It is necessary to examine how to increase the capacity of public establishments, as this will guarantee access to most beneficiaries. The NHIF has engaged 7,666 healthcare providers, 72% of which are public facilities.
More importantly, data collection will play a key role in decision making. Sustainability and strengthening of systems in the health sector requires reducing the cost of care, reducing preventable illnesses and consolidating the costs of specialist care.
The author is the CEO of the National Health Insurance Fund
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