Making Healthcare

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The monthly contribution for the informal sector contributors was later adjusted to ksh.160/= p.m. In 1998, Cap 255 was repealed and replaced by the NHIF Act No.9 of 1998, which transformed the Fund into a State Corporation managed by an all-inclusive Board of Management representing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.

NHIF Journey

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.

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