Kenya Healthcare Federation (KHF) has successfully implemented county stakeholder forum in three counties they include; Makueni, Kirinyaga and Mombasa, these forums have been supported by a grant from the Business Advocacy Fund grant. This counties are among the seven counties that are to be covered.
Inorder to achieve Universal Health Coverage (UHC), quality healthcare should be accessible without out of pocket strain. One of the major focus in county stakeholder engagement forum has been Nation Hospital Insurance Fund (NHIF).
“To reach the Ministry of Health (MOH) aspirations to achieve UHC by 2022, there is a need for greater innovation and ‘business unusual.’ It is essential that we ensure that coverage or affordable healthcare for the poor are part of the agenda and that the poor are not left out.” Dr. Amit Thakker, Kenya Healthcare Federation Chairman. Dr. Thakker further recommended that NHIF should be reformed to be more responsive to our needs and private medical insurance should also be reformed to create a more enabling environment that encourages innovation. Moreover, NHIF should only focus on growth once it has the capacity to ensure that it can handle increased coverage.
“NHIF should be able to subsidize healthcare for the poor if they are enhanced. One of the problems of collecting money from individuals is that it can cause political issues and lead to accusations of misappropriation. Even when we have a more affordable scheme there will be people who cannot pay.” Dr. Agnes Gachoki, Health CEC, Kirinyaga County.
Dr. Gachoki emphasized the importance of the concept of UHC whereby cover should be provided in a way that people are able to access care without financial burden. Moreover, NHIF has a broad scope in terms of coverage and services.
It was noted that Makueni Care is doing much better than NHIF in terms of accessibility though 500ksh is not enough to cover people in Makueni Care. From a discussion with the Governor of Makueni County, Hon Kibutha Kibwana, it was brought to light that Makueni Care can be improved in the following ways: Collaborate with NHIF to reinsure Makueni Care for a few benefits, there is a large difference between Ksh.500 a year and NHIF (Ksh. 6000 a year) which should be observed. There is scope for more schemes in between, such as Ksh. 1000, 2000 e.t.c per year and digitization to deal with fraud is necessary.
Dr. Nyangasi Governor’s, advisor Mombasa County, informed the attendees that Sustainability of UHC is an issue that must be carefully dealt with and discrepancies in county funding since the onset of devolution have been an issue. It was noted that greater transparency and accountability are required in NHIF to ensure the greatest value for healthcare. This is also necessary to deal with the delays in reimbursements being experienced in public and private hospitals in Mombasa. Moreover, Linda Mama is not working and seems to have made health outcomes worse.
There are challenges for private hospitals to provide UHC because they have to write off costs. Efforts to work with NHIF have been made but there are substantial delays in payment. Private hospitals are reluctant to try the various schemes due to difficulties working with NHIF already.
There has been uniform suggestion from the three counties that the government should have Memorandum of understanding (MoUs) with private medical insurance businesses to maximize their role in achieving UHC. We should leverage on the private sector for accountability. Moreover, Innovations and private sector involvement can be enhanced to support the drive towards 100% UHC. The private sector should be leveraged to ensure that NHIF is kept accountable and to advocate for better quality and efficiency healthcare.