Public-private partnerships to accelerate Universal Health Coverage in Kenya

Affordable healthcare for all is a priority policy agenda of the Kenyan government. The National Hospital Insurance Fund (NHIF), which is driving this mandate, has covered around 40% of the population. A majority of members, however, are working in the formal sector, and so are enrolled on a mandatory basis.

The main target for expanded coverage is the 12-million-strong informal sector. In order to help achieve full coverage by 2022, NHIF has reached out to the private sector to participate in the distribution of its products. Such partnerships will help NHIF overcome a number obstacles it faces in enrolling the informal sector:

Obstacle #1 — Reach and Education: NHIF does not have the distribution network to reach customers in remote areas. In addition, education is needed as the perceived value of health insurance is low among this population and there is no way to make premium payments mandatory.

Solution: The private sector brings a unique set of skills, infrastructure and resources that can be leveraged to help Kenya achieve universal health coverage (UHC), particularly for poor and rural families. Mobile money agents, banking agents and other innovative digital channels, which are already being used to offer financial services to hard-to-reach clients, can be used effectively to educate and enroll customers for NHIF.

Obstacle #2 —Lapsed policies: Since premiums are paid monthly and the penalty for late or non-payment is low, many customers pay NHIF premiums only when they need medical treatment.

Solution: If banks and other financial service providers were to distribute NHIF products, they could pay annual premiums upfront to NHIF on the customers’ behalf and recoup them from customers through monthly installments.

Obstacle #3 — Utilization: Formal sector employees pay mandatory premiums but do not use the NHIF cover effectively, since the benefits are not aligned with the needs and preferences of middle class and affluent customers.

Solution: Customization of NHIF products to offer higher benefits will promote better utilization among middle-class and affluent customers.

These partnerships have tremendous potential to help NHIF reach greater scale. Furthermore, success with this model will create a demonstration effect for other countries that are exploring similar partnerships between the public and private sector to achieve UHC.