NHIF foots Sh1.5bn bill as C-section births hit record high

Thursday February 28 2019

National Hospital Insurance Fund Claims and Benefits Manager Judith Otele addresses a press event in Nairobi on February 28, 2019. In 2015 the NHIF introduced outpatient cover. PHOTO | DIANA NGILA | NATION MEDIA GROUP


The National Hospital Insurance Fund payouts for Caesarean section operations have crossed the Sh1 billion mark in a year, highlighting the cost burden of the procedure to insurers.

Official records show 65,278 mothers covered by the NHIF opted for C-section, a surgical operation to help deliver a baby, in the year 2017/18, up from 21,490 in 2016/17.

This saw the national health insurer pay Sh898 million more in 2017/18 to health facilities that performed the surgeries; from Sh621 million in 2016/17 to Sh1.5 billion.

More women are delivering through elective C-Sections, a trend that has alarmed medical experts.

C-section accounted for the biggest portion of NHIF’s maternity costs, and more than a third of the women covered by the fund opted for the operation. Three in five shillings NHIF pays for maternity costs go to Caesarean sections.



In 2015, the NHIF board increased the amount allocated to C-sections from Sh18,000 to Sh30,000.

The fund pays Sh10,000 for normal delivery, having increased it from Sh6,000.

“The increase in amounts payable for the procedure is seen as one of the factors driving more women to opt for C-section, having brought on board a large number of potential users who could previously not afford it,” Mr Gilbert Osoro, the benefits and contracting manager at the NHIF, said.

Use of C-section to deliver babies has been rising fast among Kenyan women because it shortens labour and cuts risks of complications associated with natural childbirth.

The procedure also generates more money for doctors and institutions compared to natural birth.


The World Health Organisation (WHO) in 2014 predicted that C-section would become even more common in Kenya if more women could access and afford it, in spite of the procedure being unnecessary in most instances.

Elective operations such as the C-section are however not covered by private insurance providers fretful of cost implications, making the NHIF the sole underwriter of the bills.

Private insurers only cover emergency cases up to some point and limit it to the first operation with the insured required to pay out of pocket for any other instance.

The number of women delivering naturally also increased from 40,000 women to 304,000 respectively.

The sharp increase in births by Caesarean section around the world is unparalleled and unjustified, according to the Lancet series, a medical journal.


Caesarean-section births doubled to 21 percent of all deliveries globally in the past 15 years, and they are increasing annually by four percent, the Lancet says.

In Kenya, the surgery is overused in some counties and underused in others, a NationNewsplex review of maternal health data indicates.

C-section rates in Kenya differ widely across counties, with up to a 23 percentage difference between regions with the highest rate and those with the lowest.

Figures from the Statistical Review Towards the Mid-term Targets of the Kenya Health Sector Strategic Plan 2014-2018 indicate that one in four hospital births in Kiambu and Nairobi counties is by C-section.

They were followed by Kirinyaga and Embu counties, where a fifth of deliveries were through surgery. Nyeri and Machakos counties, with 18 percent each, round off the top five.

Less than two percent of women who delivered in health facilities in Tana River, Wajir, Narok and Mandera underwent surgery.


Nationally, 13 percent of women who deliver in health facilities undergo a C-section, well within the recommended rate at the population level.

“In Kenya there are urban settings where we are doing too many C-sections, yet in rural areas we don’t have enough to save women’s lives,” lead author of the Lancet series, Marleen Temmerman, professor of obstetrics and gynaecology at Aga Khan University Hospital, said.

As per the data, the amount paid to hospitals for inpatient also increased to Sh12 billion in 2017/ 2018 as compared to Sh6 billion the previous year.

In 2015 the NHIF introduced outpatient cover and enhanced benefits for ailments such as cancer and dialysis after raising the amount that workers contribute to the fund from Sh320 to a graduated scale of between Sh500 and Sh1,700 per month.

From the data, the number of people on renal dialysis also increased from 76,123 to 169,239, which means more Kenyans are in need of dialysis.