Financing universal health coverage for Kenya’s informal population

Executive Summary

Unlocking the predicament of equitable health financing in developing countries is exigent to achieving health security for their populations. The colossal challenge of an uninsured population largely engaged in the informal sector thwarts the enforcement of the current voluntary health insurance contributions. Similar to other sub-Saharan African countries, Kenya is faced with a projected unprecedented spike in urban-poor populations and noncommunicable diseases. These realities, in addition to the country’s transition to a lower middle-income economy, further curtail donor financing for health programs. This paper advances germane policy discussions and options drawing from the expertise of health economists, social protection practitioners and scholars. The paper takes cognizance of the new development in the Kenya’s national health insurance fund of 2021. These includes the repositioning of the fund as a strategic health purchaser, and the expansion of health finances through mandatory contribution by all Kenya adult. These insights are supplemented by evidence from secondary data that address key issues on sustainable, fair and enforceable financing of UHC programs in developing countries. The paper concludes that a national mandatory insurance scheme for health should be pursued. Key recommendations include compulsory contributions for affluent households as the vulnerable are covered through government funding; enhancing transparency in NHIF management to increase public trust; expanding representation in the NHIF board to include county governments; adoption of a comprehensive and uniform healthcare package to guarantee universal access by all; and contracting only health providers offering quality standardized health services at capped costs, for the fiscal sustainability of the health fund.