NHIF expert penal taskforce propose establishment of a social insurance scheme

Nairobi, Thursday, October 24, 2019    –  The National Hospital Insurance Fund (NHIF) should be restructured into a social insurance fund, the Panel of experts appointed by the Cabinet Secretary for Health Sicily Kariuki has recommended.
The Penal which was appointed to reposition NHIF into a strategic purchaser of health services handed over their final report to the CS  today and recommended the strengthening of governing structures at the NHIF and, redefining of business process and organizational structures by independent body.
The panel lead by Mr. James Wambugu also recommended that the social insurance fund should be funded through the consolidated fund to ensure all Kenyans have access to health services particularly primary health.
Speaking when receiving the report at a Nairobi hotel, the CS said the panel focused on four priority reform areas namely financial sustainability of NHIF and UHC and Health purchasing options to ensure efficient allocation of funds raised, review of the legal regulatory and governance framework of NHIF and strengthening the organizational and business process.
The panel, she explained also involved the review of all previous assessments and reform strategies instituted since the inception of the National Hospital Insurance Fund in 1965.
“The Ministry of Health appreciates the Expert Panel for their diligent and rigorous work and remains committed to the delivery of UHC and will continue to collaborate with all health sector and intersectoral stakeholders in ensuring the promise of UHC is realized,” she said.
Key reform recommendations include the need to actuarially determine premiums and benefit package entitlements to facilitate the susutainability of NHIF and strengthening and improving efficiency towards strategic purchasing, through automation and information technology.
They also recommended strengthening of the governance framework by establishing an independent accreditation and quality assurance mechanism of health service providers that will facilitate improved quality of health services.
“Having received the final report from the Experts panel, the Ministry of Health will now initiate the implementation of the proposed recommendations, while ensuring continued engagement with the County Governments as well public and private providers and the Citizens who stand to reap a great dividend in improved access to health services,” she said.
She noted that the UHC pilot has been a free service in public facilities in four counties but now in the rollout the government wants to make it more sustainable, affordable and of high quality so that every Kenyan can access health care services wherever they are.
She further explained that the  implementation process shall be expedited, with anticipation that Kenyans will soon enjoy greater efficiency in accessing NHIF services including a strengthened and responsive customer care interface.
The Health Principal Secretary Susan Mochache,  who was also present thanked the panel for the recommendations and reinstated the government commitment to deliver Universal Health Coverage.
James Wambugu, the chairman of the panel said the regulatory framework they have created NHIF stops offering private and commercial  services and stick to the three schemes proposed.
The three scheme will be mainly the formal one where civil servants , and other employees of parastatals contribute, the second is the insurance and the third one will be for the informal where government will have to pay for them through consolidated funds.
“We are going to use tax funds to help Kenyans who are not formally employed and they are the majority since formally employed together with public servants form only  25 percent of NHIF which means that  75 percent of Kenyans don’t have access,” he noted.
Those contributing informally are a small group, and  in terms of , financial sustainability informal scheme  has been running a claims ratio of about 3 times meaning that for every shilling collected , NHIF has been paying almost 3 shilling which is not sustainable.
Wambugu explained that they had looked at the benefit package and it will be possible to scale down the package to fit the money available and expand later to eventually deliver the ultimate essential health service for the entire country.
“ Our report has given progressively how it can be achieved. Government  should therefore look at its finances as a priority area ,harness tax resources by getting money where it does not have a big impact and put  in priority areas such as UHC,‘ he added.
“The  implementation plan, of the report runs until 2022 but we are hoping that the framework would have been established strongly and secured in away its going to grow and deliver universal health to Kenyans,” he said.