Public-private partnerships can boost health services
Kenya has made significant progress in reducing the burden of healthcare costs on its population.
According to World Bank, the proportion of total health expenditure, paid out-of-pocket by households has halved since 2000 to 24 per cent. However, it remains above the global average of 18 per cent, highlighting an existing gap. For instance, a recent study found that approximately one million Kenyans are pushed into poverty annually due to out-of-pocket health expenses. The Covid-19 pandemic exacerbated this gap further by disproportionately affecting low-income Kenyans.
To address this gap, the Ministry of Health’s 2030 financing strategy envisions to “ensure adequacy, efficiency and fairness in financing of health services in a manner that guarantees all Kenyans access to the essential high-quality healthcare services they require”.
According to the World Health Organisation, financing of health expenses is essential to achieve the Universal Health Care goal, which seeks to ensure all people have access to the health services they need, when and where they need them, without financial hardship.
It is for this reason that the National Hospital Insurance Fund (NHIF) was set up to play a prominent role in this strategy, by mobilising and managing mandatory pooled health revenues. The recent NHIF reforms were implemented to strengthen this mandate by making contributions mandatory for all Kenyans and by increasing contributions made by the formally employed sector. These reforms will enhance NHIF’s available resources to provide universal health care. The considerable progress made by NHIF in enabling unprecedented access to healthcare among its members should be recognised and celebrated.
However, the challenges faced by NHIF should not be ignored as well.
An expert panel recently identified several organisational weaknesses that affect NHIF’s operations and service delivery1. For instance, a recent Kemri study found that up to 52 per cent of maternity care beneficiaries had to pay out-of-pocket in spite of a promise of free care under NHIF. To plug the existing gap in ensuring Universal Healthcare Access for Kenyans, the private health insurance sector can collaborate with the government to address some of these challenges. The aforementioned health financing strategy by MoH articulates this role clearly for private insurance to complement the services provided by NHIF.
MoH also sets out a target to increase the proportion of population enrolled under voluntary health insurance schemes from five per cent to 30 per cent by 2030. Broadly, private insurance is a market-driven mechanism that allows for choice among its members. More specifically, three practical suggestions can be made for the private insurance sector in complementing NHIF and thus, supporting the universal health care agenda.
First, will be complementing NHIF coverage, especially for high-cost services. It is estimated that NHIF spends a lot of money on specialised treatments, for example, in 2018/19, the fund spent 47 per cent of all medical expenses, for such treatments, which included flying some patients abroad for medical attention. As NHIF is primarily designed to provide an essential health package to all (especially low income Kenyans), such expenses are draining its funds. This is where private insurers can step in by offering voluntary complimentary coverage for specialised cases (such as critical illness covers) so that NHIF’s burden can be reduced and focus shifted on providing essential health services to a larger population.
The writer is Director, Emerging Consumers at Britam Holdings Plc.
