How Kenya needs to frame social health insurance to win public buy in

Kenya's health sector is currently undergoing a significant transformation towards a more comprehensive and affordable social health insurance plan. Despite growing skepticism among the public regarding the effectiveness of the existing program, the government remains steadfast in its commitment to reform. Dr. Kanyenje Gakombe, Chairman of the Kenya Healthcare Federation, sheds light on the evolving landscape of healthcare in the country. Dr. Gakombe emphasized the importance of transitioning from a provider-centric approach to a patient-centric model in healthcare delivery. He highlighted the need to leverage technology to provide tailored care to individuals across all stages of life, from newborns to the elderly. By utilizing self-monitoring tools, self-testing kits, and artificial intelligence (AI), the goal is to extend level six healthcare services to the community. This shift also involves improving the tracking of medications from the factory to the patient, reducing spoilage and counterfeit drugs along the way. The integration of digital solutions aims to bring healthcare services closer to individuals, right in the comfort of their homes. Discussing the ongoing reforms in the healthcare sector, particularly the proposed transition of the national hospital insurance fund, Dr. Gakombe acknowledged the challenges faced by the government. He highlighted the need to address two primary concerns: increasing healthcare funding and optimizing resource utilization. The move towards a percentage-based contribution system, aimed at broadening the coverage beyond formal employees, is a step towards boosting available resources. Additionally, reforms in tariff structuring, claims processing, revenue collection, and expanded coverage for chronic and emergency care are in the pipeline. One of the significant hurdles identified by Dr. Gakombe is the limited contribution base, as currently only 20% of Kenyans are enrolled through formal employment. The initiative to introduce means testing for the remaining population poses a unique set of challenges, including potential misuse and fraud. To address this, he proposed exploring alternative financing models, such as earmarked taxes, to ensure broader financial participation in healthcare funding. Dr. Gakombe also highlighted the importance of building trust in the new system, citing a prevailing mistrust towards government-led initiatives. Establishing credibility and transparency within the social health insurance framework is crucial for gaining public acceptance and support. In conclusion, Dr. Gakombe expressed optimism about the future of healthcare in Kenya, emphasizing the transformative potential of digital technologies and AI. He underscored the opportunity for Africa to leapfrog traditional developmental obstacles by embracing innovation. By harnessing digital tools effectively, the continent can overcome healthcare challenges more efficiently and catch up with global standards. The ongoing reforms, though met with skepticism, hold the promise of a more inclusive and effective healthcare system for all Kenyans.