Financial protection

National Hospital Insurance Fund (NHIF) Evidence from NHA studies suggests OOPs remain unchanged likely related to unmet need (e.g. health product stockouts), balance billing and demand for more sophisticated services. National Government (Ministry of Health MOH) Evidence from NHA studies suggests OOPs remain unchanged likely related to unmet need (e.g. health product stockouts), balance billing and demand..Read More

Quality

National Hospital Insurance Fund (NHIF) There is evidence of gaps in crude coverage (utilisation based on need) including for key services e.g. antenatal care National Government (Ministry of Health MOH) There is evidence of gaps in crude coverage (utilisation based on need) including for key services e.g. antenatal care. However, access to other services has experienced gains..Read More

Access

National Hospital Insurance Fund (NHIF) There is evidence of gaps in crude coverage (utilisation based on need) including for key services e.g. antenatal care National Government (Ministry of Health MOH) There is evidence of gaps in crude coverage (utilisation based on need) including for key services e.g. antenatal care. However, access to other services has experienced gains..Read More

Equity

National Hospital Insurance Fund (NHIF) The evidence suggests gaps in financial protection with individuals still exposed to catastrophic health expenditure, and evidence of care foregone National Government (Ministry of Health MOH) The evidence suggests gaps in financial protection with individuals still exposed to catastrophic health expenditure, and evidence of care foregone County Governments (County Departments of Health..Read More

Provider payments are harmonized across schemes/revenue sources to ensure coherent incentives for providers

National Hospital Insurance Fund (NHIF) provider payment mechanisms are not harmonized across schemes. NHIF characterized by multiple funding flows that are incoherent and generate perverse incentives National Government (Ministry of Health MOH) To a significant extent. There is a limited range of provider payment mechanisms utilized e.g. salaries and line-item budgets and as such there is harmonization..Read More

Provider payment methods and purchasing arrangements promote quality of care and coordination across levels of care

National Hospital Insurance Fund (NHIF) To a limited extent. Capitation payment implementation hampered by poor provider involvement, lack of clarity in populations linked to facilities, poor information sharing and low levels of payment overall. Payment systems, contracting systems and service delivery requirements do not encourage coordination across levels of care National Government (Ministry of Health MOH) To..Read More

Providers have adequate incentives to deliver high-value services (e.g. PHC) and to serve vulnerable populations

National Hospital Insurance Fund (NHIF) No. Contracts, provider payment systems and monopsonist power are not well utilized to ensure efficiency and equity. E.g. the package development process does not account for cost-effectiveness of services, and contracting has favored urban areas National Government (Ministry of Health MOH) No. Benefit package (e.g. implicit package), financing mechanisms (e.g. line item..Read More