LSE Investigators: Lucy Kanya
Start Date: 01 June 2023
End Date: 31 May 2024
Region(s): Africa
Keywords: Universal Health Coverage, Kenya, Health Policy, WHO
Funder: LSE Research and Impact Support Fund

In 2005 the WHO member states committed to introducing universal health coverage (UHC) embodies three objectives; expanding population and service coverage and ensuring financial risk protection for individuals accessing health services. UHC remains an aspirational goal, and the diversity in the interpretation of UHC reflects contextual differences across and within countries in the social-demographic, political, economic and epidemiological profiles. Kenya aims to use the National Health Insurance Fund (NHIF) as the main vehicle for the achievement of UHC. Established in the immediate post-independence period, the NHIF is a mandatory contributory financing scheme initially covering only formal sector employees. However, with a high informal sector in the country, the scheme was seen as highly inequitable and did not also raise the expected revenue. In an attempt to address this, NHIF was revised to allow for self-enrolment by individuals in the informal sector. Exemption mechanisms targeting the elderly and secondary school students have also been established by the national government. However, coverage remains low at less than 20% of the total population, more than five decades since its inception. Concerns about the equity of the scheme persist, associated with targeting mechanisms and inefficiencies which have led to overall low enrolment. 

Current discourse on UHC stresses the importance of domestic resource mobilization to enhance sustainability of health financing. Makueni county, one of the 47 counties in Kenya has a population of approximately 900,000 people (KNBS, 20191). Most of Makueni’s population lives in rural areas, with approximately 61% living below the poverty line (KNBS, 2019). The Makueni county government launched a universal health program, dubbed Makueni Care in 2016. Makueni Care, which complements existing health financing programs, aims to improve access to promotive, preventive, curative and rehabilitative health services and reduce the population's high out-of-pocket expenditure.

The aim of this study is to analyse the impact of the Makueni care program from 2017 to 2022 on equity, financial risk protection and catastrophic health expenditure (CHE) among enrolled households. It seeks to assess (1) equity in the financing of the Makueni care program; (2) financial risk protection and estimate CHE among households enrolled in the Makueni care program and; (3) the performance of targeting mechanisms used to identify individuals and households qualified for premium exemptions. Three secondary data sources will be used: 1) The Kenya integrated household budget survey (ILO, 2019); (2) Kenya household and health expenditure and utilization survey (KNBS) and (3) Makueni care registration and utilisation data. These datasets include information on service utilisation, healthcare payments and consumption expenditure.

Please contact Dr Lucy Kanya for more information l.kanya@lse.ac.uk.