National health policies, strategies and plans play a key role in ensuring the health of a country’s population. In line with President Uhuru Kenyatta’s Big 4 Agenda, Kenya has prioritised Universal Health Coverage (UHC) through the expansion of health insurance coverage by the National Hospital Insurance Fund (NHIF).
When I took over the reins on April 14, 2020, the NHIF was undergoing structural and operational reforms guided by the Health Financing Reforms Expert Panel (HEFREP) report, in alignment to the National Agenda of achieving UHC. But implementation of such reforms requires the buy-in of all stakeholders.
Consequently, I set up five key pillars as a basis of taking the Fund to the next level and actualising its mandate. The pillars are to listen by enhancing transparency with stakeholders, promotion of inclusive leadership and appreciation of diversity by staff, restoration of trust, saving money and adding value by putting a smile on customers’ faces.
These reforms are already bearing fruit. Membership has grown from four million in 2013 to 13.5 million principal members in 2021. Revenue has also grown from Sh13 billion in 2013 to Sh62 billion in 2021. Other notable achievements include the introduction of supa cover – enhancement of the benefits available to members following the review of contribution rates in 2015.
The legal framework has also been strengthened, as reflected in the various amendments to the NHIF Act over the years. In 1965, the Act was amended to form NHIF and include ‘natives’ in the cover. In 1972, it was amended to include members of the informal sector.
In 1998, NHIF became a parastatal from a department under the Ministry of Health. The year 2015 saw a review of contribution rates while the amendment proposed in 2021 is currently at the Senate.
The 1998 amendment allowed NHIF to expand coverage to poor households and offered enhanced cover to groups such as civil servants, police, prisons officers and retired public servants. It also enhanced the implementation of sponsored programmes funded by the Government targeting the poor and vulnerable members of the society.
The programmes include free maternity cover (Linda Mama) for all women of reproductive age (2017), Health Insurance Subsidy Programme (HISP) for orphans and vulnerable children, which was introduced in 2014, HISP for older persons and persons living with severe disabilities (2016) and Public Secondary School cover (Edu-Afya), which was introduced in May 2018.
The past 12 months have seen the implementation of biometric registration and identification of members and electronic processing of claims. Digitisation has eased the cost of doing business, leading to improved customer experience and deterrence of fraud.
In the financial year 2020/2021, Sh55 billion was paid as claims, up from Sh8 billion in 2013. Countrywide biometric registration as at December 2021 stood at 4,396,389 members, 249,638 of them being from poor households. We also launched self-care platforms, complete with a 24- hour call centre that handles more than 3,000 calls, 10,000 emails and 50,000 SMS per day.
We have also strengthened the safety net for poor households through the identification of one million such households in collaboration with the Ministry of Health, Department of Social Protection and county governments. The Fund is also working with counties and constituencies such as Kisumu, Kitui, Busia and Mvita, to support low-income populations.
In 2022, the Fund proposes to enrol all Kenyans as NHIF members as envisioned in UHC and ensure 100 per cent biometric registration. With the adoption of the recommendations of the NHIF Act Amendment Bill, focus will now be on expansion of preventive, promotive and primary healthcare. The Fund will also contract more healthcare facilities and enhance collaboration with the public and county hospitals. With the enactment of the Amendment Bill, the estimated premium contribution will be about Sh110 billion per annum.
In the next 12 months, our reform agenda will include the NHIF Act Amendment Bill, 2021.
The National UHC scale-up will involve expansion of health insurance coverage in aid of poor and vulnerable households across the country and mandating national health insurance registration and contributions for all Kenyans through amendments of the NHIF Act No. 9 of 1998.
Ultimately, the ongoing reforms will reposition NHIF as a strategic purchaser of healthcare services towards the attainment of UHC.
Dr Kamunyo is CEO, National Hospital Insurance Fund
