The Kenya National Hospital Insurance Fund (NHIF) is the oldest government insurance scheme in Africa. As the primary provider of health insurance in Kenya its mandate is to provide access to quality and affordable health care for all Kenyans. NHIF membership is compulsory for all salaried employees.
The majority of Kenyans cannot access quality health care services due to high cost of
the services. It has become apparent that, although health is a basic human right as
enshrined in the 2010 Kenya constitution, only the financially able individuals can access
good health care.
It is important to note that for whatever reasons, ignoring health problems of any nation
can lead to needless suffering economically, socially and physically. The net effect of
this neglect would be devastating complications an individual’s well being with financial
and social costs that significantly reduce quality of life. Consequently this phenomenon
produces an economically weak nation.
The National Hospital Insurance Fund (NHIF) is the primary provider of health insurance
in Kenya, with a mandate to enable all Kenyans to access quality and affordable health
NHIF is positioning itself as a key player in the attainment of universal healthcare in the
country. Kenya Health Sector Strategic and Investment Plan (KHSSP) for July 2014–June
2017 defined the scope of health and related services that the sector intends to focus on
and thereby ensure universal coverage.
The National Health Insurance Fund cover has historically attracted some scepticism
from both our partners in service delivery, the health care providers and our members.
This has been due to lack of understanding of the Benefit Package which is a critical and
key component in the implementation of the Universal Health Cover.
The main challenge has been to define the benefit package in such a manner that staff
can understand what they are selling; our members can understand what they are
entitled to & the healthcare providers can understand what services they are to offer to
Historically, the Fund’s provider payments have been based on rebates. With enhanced
cover for outpatient and subsequent introduction of Capitation payment methodology
for outpatient services, a need has arisen for the development of a benefit package(s).
The benefit package should be developed in a manner that allows the client to access
healthcare in the most seamless manner.
NHIF is the vehicle that the government will use in rolling out universal healthcare in the