Kenya has implemented several key reforms to accelerate progress towards Universal Health Coverage (UHC) with mixed success. While these reforms have facilitated progress towards UHC, coverage remains low.
A significant number of Kenyans incur catastrophic expenditures from out-of-pocket healthcare payments and many more do not seek care when they fall ill due to affordability barriers.
This has called for more efforts to realise the aims and objectives of UHC by 2022. A major step has been inclusion of affordable care for all as one of the “Big Four” agenda, reaffirming Kenya’s political commitment to achieve UHC.
The sustainability of the UHC programme is nested in investments in the health system, including a particular focus on its financing architecture.
We have learnt from the UHC pilot phase - carried out in Kisumu, Machakos, Nyeri and Kitui - that it is important to utilise a financing mechanism which delivers efficiency and also ensures the pooling of health risks. This will lead to containment of health costs and reduction of inequity in access to health services.
Given that health insurance coverage in Kenya stands at only 19 per cent, the Government has made a policy decision to use the National Hospital Insurance Fund (NHIF) as one of key mechanisms for scaling up prepayment financing of healthcare and the purchasing of healthcare services.
Measures have been taken to enhance the capacity of NHIF to effectively deliver on its mandate. Some of the reforms implemented include upward revision of premium contribution rates and expansion of the NHIF benefit package to include outpatient care.
Others are several specialised services, human resource reforms to restructure the functional organisation of the NHIF and Information Communication Technology reforms to automate several core functions, including claims management, member registration and premium contributions. Several amendments to the NHIF Act have also been carried out.
While these reform initiatives have yielded significant progress, several gaps have been identified. A recent analysis indicates that among others, NHIF operates as a passive rather than strategic purchaser, is plagued by inefficiency and governance challenges and is potentially financially unsustainable.To enhance the NHIF’s capacity to deliver the promise of UHC, I established the Health Financing Reforms Expert Panel to transform and reposition NHIF as a Strategic Purchaser of Health.
The experts focused on four priority areas, which are financial sustainability of NHIF and UHC, health purchasing options to ensure efficient allocation of funds raised, review of the legal regulatory and governance framework of NHIF, and strengthening the organisational and business processes of the fund.
The panel employed a rigorous appraisal methodology that involved the review of all previous assessments and reform strategies instituted since the inception of the NHIF.
It also undertook an extensive stakeholder engagement exercise that involved health stakeholder groups including health professionals, public and private health service providers, development partners and the general public.
The ministry will soon start to implement their recommendations while ensuring continued engagement with county governments, private providers and the citizens who stand to reap a great dividend in improved access to health services.
There are five key reform recommendations. First is the need to actuarially determine premiums and benefit package entitlements in order to facilitate the sustainability of NHIF. Second is to strengthen and improve efficiency towards strategic purchasing through increased use of automation and information technology.
The third is to strengthen the governance framework by establishing an independent accreditation and quality assurance mechanism of health service providers that will facilitate improved quality of health services.
The fourth involves establishment of a mechanism that will facilitate the definition of health services and applicable technologies leading to increased efficiency in resource allocation.
And lastly is institutionalisation of a governance framework that will facilitate citizen engagement, participation in UHC programme and promote improved accountability.
Of immediate interest is the key expert finding on the potential unsustainability of NHIF driven by multiple schemes, with some of them loss making.
This finding poses a key bottleneck to the sustainability of the UHC. In this regard, expedited mitigating interventions will be undertaken, including the actuarial determination of viability of scheme premiums and their entitlements.
It is anticipated that Kenyans shall soon enjoy greater efficiency in accessing NHIF services.
The ministry remains committed to the delivery of UHC and will continue to collaborate with all health sector and intersectoral stakeholders in ensuring the promise of UHC is realised.
Sicily Kariuki is the Cabinet Secretary, Ministry of Health
