FINANCIAL MODEL AND SUSTAINABILITY OF UNIVERSAL HEALTHCARE IN
KENYA, A CASE OF NHIF
Background information
Health financing is defined as the "function of a health system concerned with the mobilization,
accumulation, and allocation of funds to meet the health demands of persons in the health
system, both individually and collectively." The purpose of health finance is to provide funding
and appropriate financial incentives to providers to ensure that all individuals have access to
effective public health and personal healthcare (Bangert et al., 2017).
Universal health coverage ensures that all people have access to preventive, curative,
rehabilitative, and palliative health care of sufficient quality to be effective while preventing
financial hardship for the user. Many parties, including governments, continue to be interested in
this. This is because it embodies three related objectives: equity in access to health services
(those who need the benefits, not just those who can pay for them); quality of health services
(enough to improve the health of those receiving services); and financial risk protection
(ensuring that the cost of using care does not put people at risk of financial ruin) (Hange, 2018).
For hundreds of millions of people, universal coverage means the prospect of better health and
protection from poverty, particularly for those in the most vulnerable situations. Universal
coverage is firmly based on the WHO constitution of 1948, which declares health to be a
fundamental human right and the Alma-Ata Declaration of 1978, which stipulates the Health for
All plan. The World Health Organization (WHO) must identify four essential components for
achieving universal coverage. One, a robust, efficient, and well-managed health system; two, a
healthcare finance system; three, access to vital drugs and technology; and, four, a sufficient
capacity of well-trained, motivated health workers (WHO, 2018).
The need for medical services looks to be growing. While some of the increase can be ascribed
to population growth and changing illness patterns, other factors such as new diagnostic and
therapeutic techniques have also contributed to the rise. According to Hsiao, (2015), these
technologies are often more expensive than existing ones and often give only a modest marginal
improvement in health outcomes compared to higher expenditures. In Kenya, for example, the
much greater cost of chemotherapy-based cancer treatment justifies this logic. Individuals have a
high tolerance for rising healthcare costs but collectively supported healthcare systems are
becoming more sensitive to rising healthcare costs.
In Kenya, the government has launched policy reforms and policies to achieve universal health
care with the backing of many stakeholders since the country's independence in 1963. Some of
these are outlined in various policy documents, such as the Kenya Health Policy Framework
(KHPF 1994–2010), Health Sector Strategic Plans, and Vision 2030 (operationalized through the
medium-term expenditure framework of 2008–2012), the Constitution of Kenya, and, finally, the
Health Bill of 2015. Notably, the government identified a good quality of life as a critical pillar
in driving Kenya's ambitions to become a globally competitive and successful nation (Enjela, &
Jam, 2015). Furthermore, the government offers a legal framework for assuring a people-driven
healthcare delivery system while bridging the geographical access divide through a devolved
governance system. These programs, it may be said, aim to provide universal health coverage to
the country's population. The government has declared access to reproductive health and
emergency medical treatment as a right for all people in the proposed Health Bill of 2015 (Björn,
2016).
The result of an unchecked cost increase could be a healthcare rationing system. Allowing the
healthcare market and prices to perform this rationing function, on the other hand, raises ethical
concerns and provokes debate about the equity of the system. This continuous dispute in most
national systems indicates a lack of understanding of three major factors: the objective need for
health goods and services, demand for those goods and services, and the growth of benefit
entitlements under the healthcare funding system (Chan et al., 2017). The relationship between
the usage or consumption of health services and health outcomes is also poorly understood,
owing to stochastic biological mechanisms determining the complexities of this association.
Problem statement and justification
As national revenues in various countries have risen, as has the burden of no communicable
illnesses, there has been an increase in demand for high quality, low-cost health care. As a result,
many countries are actively pursuing UHC, assuring quality health services for everyone at a
cost that does not place an excessive financial strain on persons seeking care (Hange, 2018). The
initiative has sparked increased attention and guidance from international institutions such as the
World Health Organization and the World Bank and created new avenues for developing
countries to learn from one another. Many countries will continue to work on UHC for many
years. It can draw more attention to health spending, health systems, and increased equity, all of
which will promote human development more widely (Gostin, & Friedman, 2017).
Many Kenyans continue to have no access to or cannot afford to pay for their health care needs
because most people live below the poverty line. The government of Kenya provides health care
cover through NHIF, which only covers outpatient and inpatient benefits to its members and
their beneficiaries. In the recent past, there have been attempt to provide UHC to the Kenyan
population by NHIF, and it was officially rolled out in 2012 to civil servants (Hange, 2018). The
need to provide UHC to all Kenyans is bound to have challenges, therefore justifying the need to
study on the possible challenges in provision of UHC in Kenya.
As a result, there is a need to reconsider financial model of universal healthcare in Kenya within
the scope of novel financing mechanisms. This will tremendously assist in beginning to tap into
potential internal sources of financing for our health sector, which could aid in broadening the
breadth of our healthcare system's internal finance.
Study objectives
The broad objective of the study is to establish the financial model of universal healthcare in
Kenya.
Specific objectives
i. To establish the influence of resource mobilization on sustainability of universal health
coverage
ii. To assess the effects of stakeholder engagement on sustainability of universal health
coverage
iii. To establish the effects of monitoring and evaluation on sustainability of universal health
coverage
Research questions
i. What is the influence of resource mobilization on sustainability of universal health
coverage?
ii. What are the effects of stakeholder engagement on sustainability of universal health
coverage?
iii. What is the effects of monitoring and evaluation on sustainability of universal health
coverage?
Hypothesis
Alternative hypothesis: There is a relationship between financial model and sustainability of
universal healthcare in Kenya
Significance of the study
The study may be expected to determine the challenges facing the financial model of universal
health coverage to realize sustainability. The study would benefit the Board of Directors and
practitioners in the health sector who closely deal with issues of sustainability of universal health
coverage. The government would have a better understanding of the factors influencing universal
health coverage sustainability and therefore come up with intervention strategies that may see the
provision and expansion of medical services through attraction of more medical service
providers to the county. To the general academia, this would go a long way in building a body of
knowledge on health and medical services. Various stakeholders can use the study to facilitate
further research in private and other public health sectors in Kenya.
Research methodology
The study will use descriptive research design. This method of research is preferred because the
researcher is able to collect data to answer questions concerning the status of the subject of
study. The target population will be the beneficiary households of NHIF and universal health
care workers. The target population of beneficiaries estimated at 872. Sampling is the process of
selecting the people who will participate in a study. This process should be representative of the
whole population. This study will adopt the stratified sampling technique. From the possible
target population of 677, stratified random sampling will be employed to select 256 sample. A
questionnaire will be used to collect primary data. The data for the study will be analyzed both
qualitatively and quantitatively. The data collected will be keyed in and analyzed with the aid of
SPSS.
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