Abstract:
This article identifies and describes the reforms undertaken by the National Hospital
Insurance Fund (NHIF) and examines their implications for Kenya's quest to achieve
universal health coverage (UHC). We undertook a review of published and grey
literature to identify key reforms that had been implemented by the NHIF since 2010. We
examined the reforms undertaken by the NHIF using a health financing evaluation
framework that considers the feasibility, equity, efficiency, and sustainability of health
financing mechanisms. We found the following NHIF reforms: (1) the introduction of the
Civil Servants Scheme (CSS), (2) the introduction of a stepwise quality improvement
system, (3) the health insurance subsidy for the poor (HISP), (4) revision of monthly
contribution rates and expansion of the benefit package, and (5) the upward revision of
provider reimbursement rates. Though there are improvements in several areas, these
reforms raise equity, efficiency, feasibility, and sustainability concerns. The article
concludes that though NHIF reforms in Kenya are well intentioned and there has been
improvement in several areas, design attributes could compromise the extent to which
they achieve their intended goal of providing universal financing risk protection to the
Kenyan population.