The factors necessary for the establishment of a sustainable National Social Health Insurance Scheme: a case study of Nairobi, Kenya
The Kenyan government developed a national Health Policy Framework in 1994 and subsequently made a proposal for the establishment of the National Social Health Insurance Scheme through the publication of Sessional Paper No. 2 of 2004. Health services are costly and their use is unpredictable, generating a demand for insurance. A proportionately large part of the Kenyan population does not have access to adequate health care. This study therefore set out to explore the factors that are necessary for the establishment of the Kenya National Social Health Insurance. The specific objectives of the study were to determine the factors to consider in establishing an affordable national social health insurance scheme; to identify the sustainability of the national social health scheme; to determine the extent to which Kenya was prepared for the establishment of a National Social Health Scheme. The findings of this study are as they are expected to contribute to knowledge on the financial implications of setting up a National Social Health insurance Scheme. The study could provide information useful for planning an effective national social health scheme. The data can also be useful to the health sector planners in the designing process of the health scheme. It is also envisaged that the findings are going to stimulate more research in this field. This was a survey research which adopted a descriptive approach to assess factors necessary for the establishment of a sustainable National Social Health Insurance scheme. The study used both random stratified and purposeful sampling techniques to 10% of the respondents from health providers and insurance firms were selected for the study. Data for this study was collected from four sources, all of which are related to the health insurance. These included: Insurance companies, both those selling general insurance and those specializing in health insurance; Health care providers, primarily those providers whose services are paid for through an insurance scheme, and the government officials in charge of health policies. For the purpose of the study, the sample comprised of 12 respondents from Hospitals, 4 Health centers, 6 Private dispensaries and 14 Nursing homes. Data was analyzed using descriptive statistics with the help of Statistical Package for Social Sciences (SPSS). Secondary data on the subject was also analyzed and interpretations made. The study findings indicated that despite the importance of the scheme, there is need to invest substantial resources that are scarce in Kenya. The study revealed that corruption and poor management led to inadequate provision of health services by NHIF. If similar trends are brought over to NHSIS, then the scheme may not be successful. The research also established that some rules and regulations governing the health issues have not adequately prepared the way for the establishment of the scheme. The introduction of the scheme was made through a political statement. There is need to review the policy issues related to the establishment of the scheme.