Extending voluntary health insurance to the informal sector: experiences and expectations of the informal sector in Kenya.

Edwine W Barasa,Njeri Mwaura,Ledia Andrawes,Khama Rogo

doi:10.12688/wellcomeopenres.12656.1

Edwine W Barasa, Njeri Mwaura + Show 2 more

Open Access

https://doi.org/10.12688/wellcomeopenres.12656.1

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Abstract

Background:Kenya has made a policy decision to use contributory health insurance as one of its key pre-payment health financing mechanisms. The National Hospital Insurance Fund (NHIF) is the main health insurer in Kenya. While the NHIF has hitherto focused its efforts on providing health insurance coverage to individuals in the formal sector, it has recently broadened its focus to include individuals in the informal sector. This paper provides an analysis of the perceptions, and experiences of informal sector individuals in Kenya with regard to enrolment with the NHIF. Methods:We collected data through key informant interviews (39) in two purposefully selected counties. Study participants were drawn from healthcare facilities contracted by the NHIF, and current, former, and prospective informal sector members. We analyzed data using a grounded approach. Results:Participants felt that the NHIF provided inadequate information about the registration and membership processes as well as benefit entitlements. There was variable and inconsistent communication by the NHIF. There was also variance between the official benefit package and the actual benefits received by members. The NHIF registration requirements and processes presented an administrative barrier to obtaining membership. The NHIF premium level and contribution mechanism presents a financial barrier to current and prospective members. Healthcare providers discriminated against NHIF members compared to cash-payers or private insurance holders. Conclusions:The NHIF could improve enrolment and retention of informal sector individuals by; 1) using communication strategies that are effective at reaching the informal sector, 2) improving the affordability of the premium rates, 3) simplifying the enrolment requirements and process, and 4) strengthening accountability mechanisms between itself and healthcare facilities to ensure that enrolled members receive the benefits that they are entitled to, and that client experience at healthcare facilities are satisfactory.

Highlights

Low and Middle Income Countries (LMICs) are increasingly prioritizing the attainment of Universal Health Coverage (UHC) (Sachs, 2012)
This commitment has culminated in the inclusion of UHC in the Sustainable Development Goals (SDGs), which were adopted by world leaders in 2015 to articulate global development priorities until 2030 (United Nations, 2015)
The analysis shows that the enrolment and retention of informal sector individuals into the National Hospital Insurance Fund (NHIF) is influenced by both purchaser (NHIF) factors, and provider factors

Summary

Introduction

Low and Middle Income Countries (LMICs) are increasingly prioritizing the attainment of Universal Health Coverage (UHC) (Sachs, 2012). Voluntary insurance contributions present a fairly small percentage of overall health revenues, even in countries that continue to attempt to collect them (Jowett, 2015; McIntyre et al, 2017). Conclusions: The NHIF could improve enrolment and retention of informal sector individuals by; 1) using communication strategies that are effective at reaching the informal sector, 2) improving the affordability of the premium rates, 3) simplifying the enrolment requirements and process, and 4) strengthening accountability mechanisms between itself and healthcare facilities to ensure that enrolled members receive the benefits that they are entitled to, and that client experience at healthcare facilities are satisfactory

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