Examining the Responsiveness of the National Health Insurance Fund (NHIF) to People Living with Hypertension and Diabetes in Kenya: A qualitative study

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 NCDs who were enrolled in NHIF. We analysed data using thematic analysis. Results: Study participants reported that the NHIF Supa Cover benefit package expanded access to services for people living with NCDs. 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 NCDs and the benefits package did not prioritise preventive and promotive services. Sometimes NCD 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 NCD 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.