National Hospital Insurance Fund’s Purchasing Mechanism And Access To Primary Care Health Services In Kenya

ABSTRACT

Health care financing (HCF) is one of the six building blocks of a health system. Kenya envisions having Universal Health Coverage (UHC) by 2022. In order to achieve this Kenya has identified and settled on National Hospital Insurance Fund (NHIF) as a vehicle towards the realization of UHC. UHC is one of the country’s “Big-four” agendas. NHIF is Kenya’s sole social insurer which collects revenue, pools and purchases health services for its members. Purchasing can be passive or strategic, for health systems to be responsive and financially fair, strategic purchasing is the way to go. NHIF is currently undertaking strategic purchasing of primary care health services (PCHS) through capitation. Strategic purchasing should guarantee access to quality, equity and financial risk protection. Despite strategic purchasing, access to PCHS still remains a challenge, with patients still lacking drugs and paying for services. Strategic purchasing requires the purchaser to engage actively in three main relationships: with Government, with healthcare providers, and with the citizens. The aim of this study was to assess the effect of NHIF purchasing mechanisms on access to PCHS for its members. To meet this aim the study focused on determining how citizens’ engagement, providers’ responsibility and County government’s role affect access to NHIF s’ PCHS. This was a descriptive cross sectional study. Data was collected from Nakuru and Nyandarua counties, using semi structured questionnaires, from 395 patients, from 66 NHIF accredited health facilities, and from 115 county health management team members. Results obtained from logistics regression analysis of citizen engagement factors and access, indicate that NHIF communication to citizens (p