You have probably suffered high out-of-pockets health costs while seeking care or while admitted at a hospital or when fundraising for friends and relatives.
It shouldn’t be this way. Everyone everywhere should access the health services they need, of sufficient quality, when and where they need them, without suffering financial hardship.
A major barrier to universal health coverage is overreliance on direct payments at the time people need care. This is reflected in the fact that a third of total health expenses are out-of-pocket costs. Health costs are a major cause of poverty, with more than one million people impoverished annually by healthcare bills.
Ministry of Health estimates show that 16 per cent of sick Kenyans do not seek medical care due to financial constraints, while 38 per cent must sell their assets or borrow to finance their medical bills. There are also hundreds of patients who are inhumanely detained in hospitals over unpaid bills. Clearly, money is a big barrier to access to healthcare.
The government’s solution to this is universal health coverage as the means to reduce the financial burden of seeking healthcare, and the National Hospital Insurance Fund has been identified as the risk-pooling vehicle that will enable equitable access to basic health services.
To realise this objective, there are plans to review and amend the NHIF Act to align it with the universal health coverage agenda. First, to change it from a hospital fund to a health fund alongside other amendments that allow for different sources of pool funds.
Currently, the NHIF pool has about 16 million beneficiaries largely from the formal sector. In the government’s plans, a further 12 million beneficiaries from the informal sector will need to be recruited through own premium contributions.
The government has committed to pay for a further 1.5 million poor families through health insurance subsidy. Community health workers (CHWs) can play a huge role in the recruitment of new NHIF beneficiaries from the informal sector by visiting households, promoting NHIF, collecting household data and facilitating premium payments through mobile money technology.
Considering the role they currently play as the community reference points for enquiry and referral, this recruitment role will extend to awareness of NHIF packages, service points, referral and demand creation and following up payments upon membership expiry.
CHWs can address the low uptake of NHIF which is partly blamed on lack of understanding of the benefits of a health insurance scheme, communication challenges and lack of trust. Due to the trust that the community places in community health workers, they can overcome the knowledge barrier which is critical if NHIF is to reach the most vulnerable.
Employing CHWs as commissioned recruitment agents for NHIF will also address the equally critical issue of high attrition due to lack of remuneration and low motivation. Despite the critical role they play in closing the gap between communities and the formal health system, many are not paid for their services and this volunteerism and minimal remuneration through time-bound community health projects has led to high attrition rates of up to 77 per cent per year.
Strategies like making them commissioned NHIF agents would go a long way in addressing some of these challenges. Their incorporation into the NHIF recruitment network is already in high gear; the Ministry of Health is in the process of configuring NHIF to accommodate them to improve coverage, even as we advocate for their integration into the formal health system as paid cadre with a scheme of service.
Dr Gitahi is Group Chief Executive Officer Amref Health Africa and Co-Chair UHC 2030