Correction to: Seeking care in the context of social health insurance in Kenya and Ghana

Suchman, Lauren; Hashim, Catherine Verde; Adu, Joseph; Mwachandi, Rita

doi:10.1186/s12889-020-09076-8

Cited by 2 publications

(1 citation statement)

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“…Some of these include general taxes, Social Health Insurance (SHI), private insurance, and outof-pocket payment (OPP) [6].Upon a rming their commitment to delivering UHC by 2030, many LMICs adopted SHI as their UHC nancing strategy. While evidence suggests that SHI increases coverage, LMICs continue to struggle with its implementation and sustainability [7]. This study seeks to analyse the potential of SHI to autonomously nance UHC in LMICs through a policy analysis case study of Kenya.…”

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Social Health Insurance for Universal Health Coverage in LMICs: A Policy Analysis of the Attainments, Setbacks, and Equity Implications of Kenya’s National Health Insurance Fund

Nungo,

Filippon,

Russo

2023

Preprint

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Background Growing evidence suggests that healthcare financing is one of the key factors for the attainment of Universal Health Coverage (UHC) in low- and middle-income countries (LMICs). Social Health Insurance (SHI) has recently earned global recognition as a possible financing mechanism to enable affordable and equitable healthcare services in resource-scarce settings. However, the path to establishing such schemes is known to be ridden with structural and political contextual challenges. Methods This work aimed to identify the enabling factors for the implementation of SHI as a financing tool for UHC in LMICs, using Kenya's National Health Insurance Fund (NHIF) experience as a case study. We used health policy lenses to analyse how actors' behaviours interplayed with other dimensions of policymaking to shape the development of Kenya’s NHIF and interpret their perceptions of policy outcomes. Drawing from 21 semi-structured interviews and an analysis of published and grey literature, we gathered qualitative as well as quantitative evidence to perform a retrospective case analysis of the NHIF experience in Kenya. Results One of our key findings is that only 17% of Kenya’s population are covered by SHI. Despite the predominance of the informal labour market in Kenya (83%), only 27% are covered by the NHIF, implying very low uptake and/or retention rates. There was little stakeholder engagement in the policy implementation process and minimum adoption of expert advice. Health financing policies were heavily influenced by political affiliations and positions of power. In addition, the purchasing and payment of healthcare was flawed, with inefficiencies including slow bureaucratic reimbursement procedures, little knowhow by rural hospital clerks, misappropriation, and a preference for private healthcare providers. The group-based parallel schemes run alongside the national scheme and the penalty payments for defaulted premiums increased the equity gap of the NHIF’s benefits for Kenya’s population. Conclusion Although the SHI system was perceived to increase the coverage and quality of Kenya’s health services, substantial structural and contextual challenges appear to have hindered its potential to finance the attainment of UHC, which should be a stepping-stone towards comprehensive healthcare attainment. Based on Kenya’s experience, we identify informal sector participation, efficiency of purchasing and payment of healthcare, and political engagement as key bottlenecks for the implementation of SHI schemes in LMICs.

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Social Health Insurance for Universal Health Coverage in LMICs: A Policy Analysis of the Attainments, Setbacks, and Equity Implications of Kenya’s National Health Insurance Fund

Nungo,

Filippon,

Russo

2023

Preprint

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Social Health Insurance for Universal Health Coverage in Low and Middle-Income Countries (LMICs): a retrospective policy analysis of attainments, setbacks and equity implications of Kenya’s social health insurance model

Nungo,

Filippon,

Russo

2024

BMJ Open

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ObjectivesTo analyse the potential of the Social Health Insurance (SHI) model to support the achievement of Universal Health Coverage (UHC) in Low and Middle-Income Countries (LMICs) through a policy analysis case study of Kenya’s National Health Insurance Fund (NHIF).DesignWe used an adaptation of the policy triangle framework to perform a retrospective policy analysis of Kenya’s NHIF, drawing from semistructured interviews and analysis of published documents and grey literature.SettingWe focused on Kenya’s NHIF as a case study.ParticipantsWe conducted 21 interviews with key stakeholders including policy experts, healthcare providers and formal and informal sector workers. We then triangulated the interview findings with document analysis.ResultsOnly 17% of Kenya’s population are currently covered by the SHI as of 2023. Only 27% of the informal economy is covered by the NHIF, implying very low uptake and/or retention rates. We found little stakeholder engagement in the policy implementation process and minimum adoption of expert advice. Our analysis suggest that political affiliations and positions of power heavily influence health financing policies in Kenya. Purchasing and payment of healthcare was found to be riddled with inefficiencies, including slow bureaucratic reimbursement procedures, little expertise by rural hospital clerks, misappropriations and favouritism of specific private healthcare providers. We also found that group-based parallel schemes and penalty payments for defaulted premiums widened the existing inequity gap in healthcare access.ConclusionAlthough the SHI system is perceived to increase coverage and the quality of health services in Kenya, substantial structural and contextual challenges appear to deter its suitability to finance the attainment of Universal Health Coverage. From Kenya’s experience, we identify little informal sector participation, inefficiencies in purchasing and payment of healthcare services, as well lack of political goodwill, as key bottlenecks for the implementation of SHI schemes in LMICs. LMICs adopting SHI need to also implement co-financing arrangements that do not impose on the population to co-finance, strategic purchasing systems, political goodwill and good governance for the SHI systems to be beneficial.

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Correction to: Seeking care in the context of social health insurance in Kenya and Ghana

Abstract: An amendment to this paper has been published and can be accessed via the original article.

Cited by 2 publications

References 1 publication

Social Health Insurance for Universal Health Coverage in LMICs: A Policy Analysis of the Attainments, Setbacks, and Equity Implications of Kenya’s National Health Insurance Fund

Social Health Insurance for Universal Health Coverage in LMICs: A Policy Analysis of the Attainments, Setbacks, and Equity Implications of Kenya’s National Health Insurance Fund

Social Health Insurance for Universal Health Coverage in Low and Middle-Income Countries (LMICs): a retrospective policy analysis of attainments, setbacks and equity implications of Kenya’s social health insurance model

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