Transforming Kenya’s Healthcare System: A Vision for a Healthier Future Reforming NHIF and Social Health Insurance for Universal Health Coverage

A friend recently asked in one of our WhatsApp groups, "If you were appointed the CS for Health, what would you do differently, considering that the most recent holder, in our opinion, had done such a poor job?" This question made me reflect deeply on the critical steps necessary to transform our healthcare system and address the many challenges we face.

Some of my colleagues went ahead to declare their availability to serve in the position of health CS, but none of them clearly outlined what their agenda would be if appointed and especially in a three-year time frame, which is what is left of the current government’s term. Here is my vision for Kenya’s healthcare system, starting with the urgent need to reform, not replace NHIF and our approach to social health insurance.

Reforming NHIF

Ensuring that every Kenyan has access to affordable and quality healthcare is a cornerstone of my vision. The National Hospital Insurance Fund (NHIF) has the potential to be a game-changer, but it needs significant reforms. In my opinion NHIF had managed to achieve roughly 40% of the UHC dream/goals, replacing it with a new entity is completely unnecessary and we would rather spend our energy and focus on making what we have in place better.

• Efficiency and Inclusivity: The NHIF needs to be more efficient and inclusive. According to the 2019 Kenya Household Health Expenditure and Utilization Survey, out-of-pocket health expenditure remains high at 26% of total health expenditure. This indicates the need for a more effective health insurance system that covers more Kenyans.
• Tax-Funded Social Health Insurance: To reduce the burden on the small percentage of Kenyans in formal employment, we should consider implementing a tax-funded social health insurance scheme. A study by the African Population and Health Research Center suggests that tax-based financing can enhance equity and financial protection in health.
• Mandatory Health Insurance: Health insurance should be mandatory for all Kenyans, with subsidies for low-income households to ensure affordability. The World Bank's Universal Health Coverage Study Series indicates that mandatory health insurance schemes with targeted subsidies can significantly increase coverage and access to healthcare services. Rwanda has achieved 90% insurance coverage using this approach and is a model that we should emulate and seek to match.

Challenges and Solutions

The recent establishment of the Social Health Authority aimed at advancing Universal Health Coverage (UHC) though a step in the right direction was unnecessary as all the reforms we require could have been implemented under the existing NHIF structure. However, several challenges need to be addressed:

1. Budgetary Allocations: Recent budgetary allocations have been insufficient to cover the expansive needs of UHC. We need to ensure that the allocation per capita is enough to provide comprehensive coverage.
2. New Benefits Packages: While the new benefits packages are ambitious, they are not matched with adequate funding and infrastructure to support them, risking over-promising and under-delivering.
3. Operational Challenges: Rolling out UHC across the country, especially in remote and underserved areas, presents immense logistical challenges. Proper planning and resource allocation are essential to avoid chaotic and inefficient implementation.
4. Public Trust: Given past failures, the public's trust in new initiatives is low. Building credibility and demonstrating tangible improvements quickly is essential to gain public support.

A Call to Action

Reforming NHIF and implementing a tax-funded social health insurance scheme are crucial steps toward achieving UHC in Kenya. By addressing the challenges of budgetary allocations, operational logistics, and public trust, we can create a healthcare system that truly serves all Kenyans. Let's not just dream about a healthier future—let's work together to make it a reality.

Next week I will seek now to address the substance of actual reforms that the healthcare system needs to make it a more responsive system to the healthcare needs of Kenyans. I know that it is unlikely that I will be appointed the CS health, but reaching out to whoever will be appointed, kindly consider a few of the points I have raised around healthcare financing.