NHIF Accelerates Implementation of Reforms To Secure Members’ Healthcare Needs

NHIF Accelerates Implementation of Reforms To Secure Members’ Healthcare Needs

Universal Health Coverage (UHC) means that all Kenyans have access to the health services they need, when and where they need them, without financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care. The Government is keen on ensuring all Kenyans have access to quality healthcare services they need without being pushed into poverty due to high costs. Accordingly, the UHC scale-up is at top gear with the National Hospital Insurance Fund (NHIF) identified as the implementer under the guidance of the Ministry of Health. NHIF has, over the last 55 years, contributed in a big way to the access to healthcare among Kenyans; hence it is essential. To ensure a seamless and efficient implementation process, the Government initiated a raft of reforms on NHIF to transform and reposition it from a passive to a strategic purchaser of healthcare services. Let’s keep engaging to make NHIF a sustainable organization towards the delivery of UHC

Dr. Peter Kamunyo, NHIF CEO

Implementation of the Recommended NHIF Reforms Towards UHC Scale -Up

In 2018, the Kenyan Government appointed a Health Financing Reforms Expert Panel (HEFREP) to develop NHIF’s reforms recommendations. HEFREP suggested 55 recommendations following extensive consultation with different stakeholders and public participation across all the 47 counties. The reforms are at various stages of implementation. The reforms aim to transform NHIF into a sustainable institution, with members’ expectations at the centre of operations. Hence, each reform, geared towards a patient-centred approach. Some of the ongoing reforms are as follows: 

  1. NHIF Amendment Bill 2021: The proposed NHIF Amendment Bill 2021, currently in Senate, will positively transform the Fund’s operations. Key proposed amendments include the enforcement of mandatory contributions from all Kenyans, identifying and supporting the poor & vulnerable members of the society and cushioning the Fund against abuse either from fraudulent activities or high rates of default by contributors, among many other proposals. Therefore, the passing of the amendment bill remains a critical component in the implementation of UHC as it provides a legal framework that anchors the other reforms. 
  2. Implementation of Biometric registration & identification of all beneficiaries: The proposed Bill gives provisions for NHIF to minimize fraud, wastage, and abuse from within and outside the Fund by imposing penalties on those found culpable. One way to arrest this was to migrate NHIF processes to the digital platform fully. Currently, The Fund is in full gear with all branches countrywide carrying out the biometric registration drive to ensure members are captured biometrically. In addition, digital transformation will enable ease of doing business, improve efficiency by reducing the turnaround time of processes, and curb fraud. 
  3. Adoption of Electronic Claims Processing: NHIF recently launched the electronic claim management system (E-Claims) in health care facilities where hospitals submit paperless claims online. NHIF has connected all Government hospitals from Level IV to Level V, all Faith-Based hospitals and all Private hospitals contracted with NHIF. The paperless E-Claims system will significantly enhance efficiency in claims processing by shortening the claims processing turnaround time and consequently ensure timely reimbursement of the healthcare providers for services offered to NHIF members.
  • Upgrading the Customer Experience Centre to Ensure Availability Around the Clock (24/7): NHIF has a fully operational call centre with over 75 staff members skilled in different customer/patient journeys. The team never sleeps! The Fund receives over 3,000 calls, 10,000 emails, and 50,000 short messages (SMS) on any given day. The call centre is toll-free number 0800 720 601. 
  • Creation of Customer (Members, Employers & HCPs) Self-Care Platforms: NHIF introduced self-care platforms such as the USSD *155#, ‘My NHIF’ App, and web-based platforms to bring services closer to members. Further, members can: -Monitor their accounts through the self-care platform that enables them to monitor the frequency of usage of the principal account. 

– Query status and check on use through their statements will make the principal member responsible for their account. 

-NHIF members can also receive SMS’ as a mode of notification of usage at any service point. In addition, members can report cases whereby the amount billed is fraudulent or not commensurate with the services offered. 

All these perspectives ensure that the initiatives around the various anti-fraud programs are adhered to, thus reducing fraud losses. 

  • Organizational Structure Alignment for UHC Implementation: The above reforms will not be successful without a skilled workforce. NHIF is reviewing the organizational structure to align the structure around the core functions for UHC implementation. Health is an emotive matter that requires the right personnel to manage the affairs of the organization. 
  • Increased Accessibility and Enhanced Communications Channels: NHIF continues to strive to bring services closer to Kenyans! NHIF has 70 branches, 33 satellite officers and 53 Huduma centres countrywide. In addition, the Fund recently launched a new-look NHIF website, which is loaded with information sought. Visit www.nhif.or.ke and have an exciting experience navigating through the pages.
  • Review of Benefits Package for Comprehensive Care: The reforms on the benefits package review will ensure that Kenyans can access comprehensive care as members, therefore reducing the out-of-pocket payment for healthcare services. In addition, the reimbursement rates have been standardized across all accredited hospitals. They have been rationalized considering the recommendations from the appointed panels, market rate, pricelists from various hospitals and past benefits utilization experience. 
  • Expansion of Healthcare Service Providers Network to Enhance Healthcare Services

The reforms include healthcare providers network expansion to enhance access to healthcare services to members, especially in poor, rural, and/or marginalized areas, to remedy the pro-urban and pro-rich geographical distribution. NHIF is currently contracting for 2021/2024 cycles to address the gap, where contracts will be based on either comprehensive or non-comprehensive cover. There are 7,766 HCPs which comprise 5,833 GoK (75%), 314 Faith-Based (4%) and 1,619 Private (21%) HCPs, which possess the requisite licenses and registration certificates that are ready for re-contracting. In addition, NHIF has engaged the Council of Governors (CoG) to ensure no public health facility is left out.

While NHIF has had its share of challenges, there has been a deliberate strategy to turn around the negative perception and downward trends in operational issues to a profitable organization poised to deliver UHC, where no one should be left behind. 


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