Abstract:
Objectives To assess the responsiveness of the National
Health Insurance Fund (NHIF) Supa Cover benefit package
to the needs of individuals with diabetes and hypertension
in Kenya.
Design, setting and participants We carried out a
qualitative study and collected data using key informant
interviews (n=39) and focus group discussions (n=4)
in two purposively selected counties in Western Kenya.
Study participants were drawn from NHIF officials, county
government officials, health facility managers, healthcare
workers and individuals with hypertension and diabetes
who were enrolled in NHIF. We analysed data using a
thematic approach.
Results Study participants reported that the NHIF Supa
Cover benefit package expanded access to services for
people living with hypertension and diabetes. However, the
NHIF members and healthcare workers had inadequate
awareness of the NHIF service entitlements. The NHIF
benefit package inadequately covered the range of
services needed by people living with hypertension and
diabetes and the benefits package did not prioritise
preventive and promotive services. Sometimes patients
were discriminated against by healthcare providers
who preferred cash-paying patients, and some NHIF-
empanelled health facilities had inadequate structural
inputs essential for quality of care. Study participants
felt that the NHIF premium for the general scheme was
unaffordable, and NHIF members faced additional out-of-
pocket costs because of additional payments for services
not available or covered.
Conclusion Whereas NHIF has reduced financial barriers
for hypertension and diabetes patients, to enhance its
responsiveness to patient needs, NHIF should implement
mechanisms to increase benefit package awareness
among members and providers. In addition, preventive and
promotive services should be included in NHIF’s benefits
package and mechanisms to monitor and hold contracted
providers accountable should be strengthened.
