Role of Social Health Insurance in Achieving Universal Health Coverage

Background: Sustainable financing is the key to achieving universal health coverage (UHC). Kenya is keen on attaining the UHC by expanding the National Hospital Insurance Fund (NHIF). Methods: We extracted findings from the National Health Accounts (NHA) for Financial Years 2016/17 to 2018/19, the 2018 Kenya Household Health Expenditure and Utilization Survey, and evidence from other health sector documents that assessed health sector performance. Publications reporting access to health services were included to consolidate the findings. The Kenya National Health Accounts (NHA) estimation was done to track the flow of funds to the health sector. Results: The Out of Pocket expenditures and non-profit institutions serving households controlled 24.3% and 17% of Current Health Expenditure (CHE) respectively in 2018/19 from 22.7% and 20.3% in 2016/17. The MOH allocation increased to 15.3% of CHE in 2018/19 from 14.9% in 2016/17 while counties' remained relatively the same in 2018/19 at 18.3% compared to 19.3% in 2016/17. Also, social Health Insurance increased gradually from 10.3% in 2016/17 to 13.8% in 2018/19. Households that reported illness but did not seek health care increased from 12.7% in 2013 to 28% in 2018 citing mainly self-medication and lack of money (45.2% and 19.4% respectively) as the barriers to healthcare utilization. Moreover, 68% of households reported receiving quality health care services in 2018, an increase from 57% reported in 2013. Conclusion: NHIF must expand population and service coverage and reduce out-of-pocket payments with the new reforms. This will have positive implications for the health system goals of equity, efficiency and quality. The NHIF national and county government should also make deliberate efforts to align the design and implementation of such reforms with strategic purchasing actions that aim to improve the health system in general.