The introduction of UHC, named “Afya Care” described above supports only 5% of the population (4 counties) during its pilot phase. In 2022, the World Bank funded programme will be rolled-out across all counties (Kariuki, 2019). In addition to the four counties covered by ‘Afya Care’, one county that is not among the trial counties has implemented‘Makueni care’ which covers access to public health services. This leaves 42 counties to rely on NHIF.  In those counties, members (formal and informal workers) have to either make monthly contributions in order to access either public or private health care or pay at the hospital similar to other community members. NHIF has contracted hospitals under three categories (A, B and C) for contributors. Under category A (government hospitals), members enjoy full and comprehensive cover (maternity and medical diseases including surgery). Category B (some private and mission hospitals), members receive a comprehensive cover but in case of a surgery, the member would co-pay.  Category C (private), members pay specified daily benefits (NHIF, 2020). If the fee in a particular hospital exceeds the insurance limit, patients are required to pay the balance. Patients are therefore encouraged to visit hospitals that are within the NHIF cover.

To become members, those working in the informal sector can opt to pay a monthly premium of 500 Kenya Shillings (about $5.00 US dollars) per household to access both outpatient and inpatient services or directly pay for the services at the point of care. The formal sector contributions are based on salary scales (representing 2.4% of the gross salary) (Okungu, Chuma, & McIntyre, 2017). In addition to issues around health care inaccessibility due to distance to health care providers (geographical characteristics)  and inability to pay for the health services (individual characteristics), quality of care is also impaired in many counties as several facilities cannot supply sufficient amounts of drugs for non-communicable diseases and also experience inadequate staffing levels (Barker, Mulaki, Mwai, & Dutta, 2014; Turin, 2010). Data collected in 2010 from a nationally representative sample of public health centers and dispensaries across all 8 provinces (before devolution) in Kenya revealed evidence of pro-rich inequalities for electricity and laboratory services, and for availability of drugs and qualified staff. Less than 20% facilities had all drugs on the tracer list in stock. These resources provide salient inputs into the quality of care provided at health facilities (Toda et al., 2012). Societal (social and cultural) factors can also influence health seeking behavior, for instance, past interactions with a favorable view of services may result in continuing visit to the same provider. Similarly, stigma around certain conditions is a contributor to where and how people seek or avoid seeking care (Turin, 2010). Provider characteristics also provide a range of actions that a person can take when in need of care (Awiti, 2014).

References:

Awiti, J. O. (2014). Poverty and health care demand in Kenya. BMC Health Services Research, 14(1), Pp. 560. https://doi.org/10.1186/s12913-014-0560-y

Barker, C., Mulaki, A., Mwai, D., & Dutta, A. (2014). Devolution of healthcare in Kenya assessing county health system readiness in Kenya: a review of selected health inputs. Washington, D.C. https://doi.org/10.13140/RG.2.2.36622.87363

Kariuki, S. (2019). World Health Day: Universal Health Coverage – Everyone, Everywhere – Celebrating Kenya’s journey towards universal health coverage. https://www.health.go.ke/wp-content/uploads/2019/04/WORLD-HEALTH-DAY-SUPPORT-07-04-2019.pdf

NHIF. (2020). Inpatient services.

Okungu, V., Chuma, J., & McIntyre, D. (2017). The cost of free health care for all Kenyans: assessing the financial sustainability of contributory and non-contributory financing mechanisms. International Journal for Equity in Health, 16(1), 39. JOUR. https://doi.org/10.1186/s12939-017-0535-9

Toda, M., Opwora, A., Waweru, E., Noor, A., Edwards, T., Fegan, G., … Goodman, C. (2012). Analyzing the equity of public primary care provision in Kenya: variation in facility characteristics by local poverty level. International Journal for Equity in Health, 11(1), 75. https://doi.org/10.1186/1475-9276-11-75

Turin, D. R. (2010). Health Care Utilization in the Kenyan Health System: Challenges and opporunities. Inquiries Journal, 2(9), 2–3. http://www.inquiriesjournal.com/articles/284/health-care-utilization-in-the-kenyan-health-system-challenges-and-opportunities