EVIDENCE BRIEF - Lessons from the Kenya National Social Health Insurance Reforms and Implementation

EVIDENCE BRIEF Lessons from the Kenya National Social Health Insurance Reforms and Implementation Background Social health insurance (SHI) is a health finance mechanism that seeks to equitably protect people against financial and health burdens through risk pooling, which considers both the health risks of the people and the contributions by individuals, households, enterprises, and the government. [...] Key NHIF reforms over the past two decades >>> Expansion to cover both inpatient and outpatient services for both the national scheme and specialised services for all the NHIF schemes >>> Transfer of the free maternity policy implementation to NHIF, rebranded as ‘Linda Mama’ (Swahili for take care of the mother) programme, and the addition of antenatal care, post- natal care and delivery-related c. [...] The NHIF Board of Directors consider the inspection while voluntary members pay a monthly flat rate premium of recommendations, gazettes the hospital, and signs a contract KSh 500 (USD 5), which they submit to district and provincial between the NHIF and the hospital that specifies the category offices [ 13, 15, 18]. [...] NHIF also has overlapping provider payment was attributed to their opposition to the reforms, driven by contracts where, the NHIF pays the same facility an annual their mistrust of the NHIF and fear about the implications of capitation fee for outpatient care for the public, and an annual the changes to their business [12]. [...] This requires the government of Strengthen NHIF revenue collection: Kenya’s experience Kenya putting in place measures to strengthen NHIF suggests that the main way for the NHIF to improve its governance and accountability, stakeholder engagement, revenue collection is to moblise and increase NHS premium use of evidence to inform reforms and implementation, contributions from the informal workers.