Center for Health Market Innovations (CHMI)

Programs

National Social Health Insurance Fund

last updated Mar 26, 2013

Overview

Legal Status: 
State/government
Year Launched: 
2012
Stage: 
Pilot/startup stage
Income Level of Target Population: 
All income levels

Funding

Primary Source of Funding: 
Membership/subscription fees
Additional Source(s) of Funding: 
Government

Scale

Number of Clients Served: 
60-80% of Kenyan population
Summary: 

The National Social Health Insurance Fund intends to systematically enroll 60-80 percent of the Kenyan population in a national insurance scheme offering a comprehensive benefits package over a transition period of nine years.

Key program components: 

The policy will be income-rated for employees and employers. A flat rate will be applied for the self-employed and individuals in the informal sector. Premiums will be collected by payroll deduction for individuals in the formal sector. For the very poor, the government will subsidize the premiums. For certain services, notably long-term care, patients may have a co-pay. Flat rate remuneration per inpatient day has been proposed.

The government plans to offer a comprehensive standard benefit package proving coverage at health centers, dispensaries, district and sub-district hospitals, provincial hospitals and national referral and teaching hospitals. Services for HIV/AIDS and TB will be included, but they will be accounted for separately and potentially co-financed, at least initially, through NGOs and other external mechanisms.

Program history: 

Since its independence in 1963, Kenya has mainly had a tax-funded health system. However in 1989, user-fees were introduced. User fees were abolished for out-patient care in 1990 but re-introduced in 1992 because of budgetary constraints. Since 1989 the Government of Kenya has been interested in social health insurance to reduce out-of-pocket health expenditure and to increase access to out-patient and in-patient care for all Kenyans. An inter-sectoral task force was established to prepare a national strategy and legislation as the necessary first step. A strategy paper was developed in 2003, and submitted to the Kenyan parliament in 2004. The parliament passed the NSHIF in December 2004. However, the president decided that it still needs amendments and returned it to the parliament for debate.

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