Making Healthcare
Better
The Beginning
Our journey began in June 1963 when the then-Attorney General Sir. Charles Njonjo wrote to the newly empowered Native administration a proposal to have a national health scheme that would somewhat bring equality among Europeans, Asians, and Africans.
Previously, the Europeans and Asians had their health insurance cover, the European Hospital and Treatment relief Fund, and the Asian and Arab Fund Authority. The insurance cover would help the contributors obtain treatment from the more expensive and exclusive hospitals, while the natives could only access the ill-equipped and overcrowded government hospitals.
Sir. Njonjo’s dream was later realized in June 1966 when an interim National Health Insurance Fund (NHIF) Scheme team delivered the NHIF act marking the start of The State Parastatal. In the same year, NHIF was established under CAP 255 of the Kenyan Laws to be run by an Advisory Council appointed by the Minister of Health. It catered for salaried employees earning Kshs.1,000 and above per month, making a monthly contribution of Kshs.20/=.
In 1972, an amendment was made to incorporate informal sector members (Self-employed) at a monthly contribution of Kshs.60/=. The monthly contribution for the informal sector contributors was later adjusted to ksh.160/= p.m. In 1998, Cap 255 was repealed and replaced by the NHIF Act No.9 of 1998, which transformed the Fund into a State Corporation managed by an all-inclusive Board of Management representing various stakeholders and interest groups.
In April 2015, the NHIF contribution rates were revised to account for the increased cost of healthcare services and expand the benefit package. This led to the expansion of the NHIF Benefit package from the previous only one benefit (inpatient) to the current ten benefits, which NHIF rolled out successfully and has been running since 2015.
In 2018, the Kenyan Government appointed a Health Financing Reforms Experts Panel (HEFREP) for the Transformation and Repositioning of NHIF as a Strategic Purchaser of Healthcare Services towards Attainment of UHC by the Year 2022. The HEFREP report suggested 55 recommendations following extensive consultation with stakeholders and public participation across 47 counties.
Among the reforms recommended was a legal framework within which NHIF operates to align its processes to UHC. Therefore, the NHIF Act 1998 was amended and became law in 2022 as the National Health Insurance Fund Act. One new aspect introduced is the name change to the National Health Insurance Fund!
NHIF has approximately 14 million registered principal members and about 12.9 dependants, translating to approximately 22.8 million beneficiaries. However, due to the existing provision of voluntary membership for the informal sector, which leads to a high dropout rate of this cohort of members, the active members are only 5 million principal members with approximately 6.6 million dependants under them, totalling only 11.6 million active beneficiaries.
Implementing UHC in Kenya through NHIF means that every Kenyan resident should be a registered beneficiary and contributor to the national health insurer.
We endeavor to provide medical insurance cover to all our members and their declared dependants (Spouse and children), by facilitating access to quality healthcare through strategic resource pooling and healthcare purchasing. The Fund’s vision is “A world-class universal social insurer.” To be achieved through its Mission, ‘To contribute towards Universal Health Coverage through the provision of affordable, accessible, sustainable and quality health insurance through strategic resource pooling and healthcare purchasing in collaboration with stakeholders.’
We commit ourselves to observing the highest ideals of customer responsiveness, ethics and professionalism, team spirit, partnerships and collaborations, innovation and creativity, and corporate social sustainability.
- Increase the numbers of principal members from 7 million in 2018 to 19 million by 2022
- Enhance revenue inflow and its utilization
- Enhance compliance to good governance
- Enhance synergies in information and resource sharing with stakeholders and partners
The governance and management structure is organized as per the recommended international best practice for Semi-Autonomous Insurance Funds. The Board of Management (BoM) is the governing body of NHIF, as set out in the NHIF Act.
We offer health insurance coverage for both In and Outpatient visits at the over 8000 private and public NHIF contracted hospitals countrywide. These services are under the National Scheme dubbed ‘SUPA COVER’ for those registered and, remit monthly contributions. Rates for the informal sector are at a fixed amount of KES. 500 a month and for those in the formal employment the rates are at graduating scale between Kes150-1700 monthly.
- The Outpatient benefits include consultation, lab investigations, daycare procedures, drugs and dispensation, health education, wellness and counselling, vaccines immunization as per the KEPI schedule.
- We further cover specialized treatment for renal dialysis, radiology and chemotherapy for cancer treatment, surgical procedures, maternal care and reproductive health services, emergency road evacuation, overseas treatment and rehabilitation for drug and substance abuse.
- We cater for the disadvantaged in the society through government-sponsored programs. These programs include:
- Linda Mama Program, a health insurance cover for expectant mother and their newborn children with no other form of insurance. The program offers ante-natal, delivery care, postnatal care, referral, and infant care.
- Edu-Afya the Secondary School Cover whereby the government launched and rolled out a free comprehensive medical cover for all students in public secondary schools.
Download EduAfya Information Pack - Health Insurance Subsidy Program which covers the poor, orphans and vulnerable children (OVC).
- Edu-Afya the Secondary School Cover whereby the government launched and rolled out a free comprehensive medical cover for all students in public secondary schools.
- Health Insurance Subsidy Program which targets the old and persons with severe disabilities (OPSD).
- Our cover has no upper age limit
- No filtering for pre-existing illnesses on enrollment
- Family based
- NHIF’s membership has steadily grown over the years to 9Million FY 2019/2020
- NHIF has increased coverage of the informal sector from less than 200,000 in 2005 to Over 3.2M in 2019/2020
- The total contribution revenue has increased from KES 3.1 billion in FY 2006/07 to around KES 55B in projected for FY 2019/2020
- The pay-out ratio has increased to 90% in FY2017/18 from 32% in FY06
- Increased investment in ICT; claims notification, revenue collection (EFT payments, MPESA)
- NHIF on average pays claims within 14 working days
- Revision of hospital rebates to a maximum of kshs.4,000 up from kshs.2,400 depending on category.
- The Fund has contracts with over 8,000 accredited health facilities (Inpatient & Outpatient) and connected to the Fund’s system
- Reduced the average length of stay in hospitals from 12 days in FY2003/04 to the current 4 days
- Improved public Image
- Introduction of the self-care portal in 2020 whereby members can select their preferred outpatient hospital, check their status and dependants remotely using the USSD *155#, MY NHIF APP, and the self-care portal on our website. This has helped in enhancing the synergy in information and resource sharing with stakeholders.
- Enhancing accessibility by having 95 fully autonomous branch and satellite offices and our presence in the 47 Huduma centers countrywide.
In the financial year 2019/2020 NHIF managed to pay for a total of 4.44 million hospital visits, thus 1.43 Million cases for inpatient and 3.01 Million cases for Outpatient services. This in turn has gone into saving millions of Households catastrophic financial losses brought about by health-related issues.
Besides shelter, food, clothing, and education having a health insurance has proven to be a basic need that keeps millions of families from losing their properties, and livelihoods due to unexpected illnesses.
