Role of County Health Governance in Implementation of Social Insurance National Scheme in Selected Counties in Kenya

Abstract

Health care financing (HCF) is one of the building blocks of a health system. Kenya envisions to have Universal Health Coverage (UHC) by 2022. To achieve this, the National Hospital Insurance Fund (NHIF) was identified as a vehicle towards the realization of UHC. NHIF collects revenue, pools risks, and purchases health services for its members. NHIF uses capitation as a strategic purchasing model to provide primary care health services (PCHS). This study aimed to establish the role of County Health Governance in implementation of the NHIF national scheme. Specifically, the study sought information on NHIF’s communication with the County Health Management Team (CHMT), CHMT knowledge of NHIF national scheme guidelines, suitability of county health facility Infrastructure , adequacy of NHIF capitation funds, NHIF accountability and how they all influence provision of NHIF primary care health services. This was a cross sectional research. All 120 County and Sub-County Health Management Team members were purposively sampled from Nakuru and Nyandarua Counties, a 96% (115) response rate was achieved. Results showed that, 64(56%) of respondent said NHIF was accountable to the population, 73(63%) said the county health facility infrastructure was adequate and 67(58%) said there were guidelines directing implementation of NHIF PCHS. However, 66(57%) said patients were not accessing NHIF primary care health services, 70(61%) said capitation funds were not adequate and 59(51%) said communication from NHIF to them was inadequate. Chi square results indicated that all variables, NHIF communication χ² = 5.364, p < 0.05, availability of guidelines χ² = 10.447, p < 0.05, suitability of county health facility infrastructure χ² = 13.199, p < 0.001, adequacy of NHIF capitation funds χ² = 6.956, p < 0.05 and NHIF accountability χ² = 10.982, p < 0.05 were scientifically significant and influenced implementation of the national scheme outpatient services. The study concludes that there is minimal participation of the CHMT in NHIF decision making and this hinders successful implementation of the NHIF National scheme. The study recommends that 1) NHIF improves communication with the CHMT members, so as to involve them in the implementation of NHIF national scheme, 2) NHIF to raise awareness of the strategic purchasing function in order to promote a shared understanding which will enrich knowledge of the roles and responsibilities of all the players including the County and National governments, NHIF, Citizens and providers.