Funding for health in Kenya comes from the national treasury, donor support, out-of-pocket expenses, insurance, and private investment.
According to Health Economist Dr. Daniel Mwai, national and county governments control about 33.6% of health financing while insurance penetration stands at 20%, with 80% of Kenyans having no no insurance coverage.
Achieving universal health coverage (UHC) was linked to a financially viable health system for the country’s 50 million people.
But only 10 million people are members of the National Health Insurance Fund (NHIF), which has been identified as a way to kick-start UHC implementation, yet it controls only 13.8% of the funding scheme.
Dr Mwai believes that depending on the NHIF to fund health services for UHC means Kenyans are harboring unrealistic dreams.
This means increasing the number of households contributing to the NHIF considering that “a disease does not ring a bell”.
In a previous interview, NHIF CEO Dr Peter Kamunyo said that of the 10 million households registered with the NHIF, only 5.6 million were active as of May 2021.
In the 2021 financial year, the NHIF collected 61.53 billion shillings from its members, of which 54.66 billion shillings were paid for hospital claims.
Phone calls to Dr. Kamunyo to shed light on implementation plans were unsuccessful.
Dr Ruth Masha, for her part, says the NHIF is a key player and that “the government needs to put everyone under some form of insurance for the sustainability of quality healthcare”.
Although the NHIF pays for a variety of services ranging from deliveries, surgeries and cancer treatments, hesitant members of the program cite the inability to deliver expected services and inefficient turnaround times.
“I used the NHIF for surgery, but the main challenge was changing hospitals to access services when I moved from Mombasa to Nairobi,” recalls Winnie Otieno, communications specialist. “I had to pay out of pocket because it was an emergency.”
Then there is the case of Nyambura Mwaura whose delivery cost of Sh30,000 to a private hospital was paid by the NHIF.
But the mother-of-three, who suffered from eclampsia, spent an extra night in hospital because the NHIF card identified her as male.
Dr Mwai attributes the laxity in NHIF membership to pre-independent functioning, where he focused on members in formal employment, who make up only 25% of the population.
Aloïse Gikundi said that investing more in preventive health care to save on curative care would reduce the cost of health care, starting with “reorganizing public health care at the community level”.