An Investigation of Factors Affecting the Implementation of Universal Health Coverage through Social Health Insurance in Government Ministries in Kenya
Otieno, James Andako
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Universal Health Coverage means an effective access to affordable quality health care and financial protection in case of sickness. Though health care may be available access can be hampered by financial protection. Social Health Insurance provides this financial protection. Many countries especially the developed countries have ensured Universal Health coverage using Social Health Insurance. Developing countries have implemented universal coverage using Social Health insurance in various levels. In Africa, Ghana has shown a great step covering the population through Social Health Insurance. In Kenya however there still exists low financial protection incase of sickness. Payments through out of pocket for health care still occur denying many that are not on any form of health insurance from accessing healthcare. Social Health insurance has been implemented through the National Hospital Insurance Fund. This paper reviewed the problem of slow implementation of universal health coverage using Social Health insurance despite efforts that are in place in Kenya. It sought to investigate the factors in the human resource departments of forty three Government Ministries headquarters. The paper was based on the Change theory due to insurance. Empirical studies were reviewed based on studies in the World, Africa and Kenyan situation. Literature was reviewed on the four factors that may affect implementation of Universal Coverage through Social Insurance. A conceptual framework was developed based on Implementation of Universal Health coverage as the dependent variable and legal, social, economic and demographic factors as independent variables. Political environment and donor interventions were reviewed as intervening variables. A descriptive survey method was adopted and through a census approach questionnaires were administered to 39 heads of Human Resource Departments in Government ministries after a validation of the instrument through a pilot in four ministries. Data was analysed using SPSS. From the findings, the researcher found that implementation of Universal Coverage through Social Health Insurance in Government ministries does not meet all requirements of financial access as required. This was explained largely by economic factors, demographic factors, social factors and legal factors. Economic factors included rates imposed and low disposable incomes whereas demographic factors were mainly high population growth, high number of the poor and many dependants. Social factors that influence were mainly the stakeholder consensus and representation of the grass roots in decisions on social insurance. Legal factors such as amendment of NHIF Act and legislation on health insurance were key in implementation of UHC through SHI. Political environment was found to highly influence implementation of Universal Health Coverage through Social Health Insurance. The study recommended non arbitrary increase in rates, amendment of social health insurance related legislations, stakeholder consensus, proper management of Social Health Insurance agency institutions, non discrimination in social health covers and greater political participation to encourage implementation of Social Health insurance. Studies using case studies and on different levels of employees as well as extending the study to private sector and informal sector has been suggested as results may reveal other areas of intervention to ensure proper implementation of Universal Health Coverage through Social Health Insurance.