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Expanding access to NHIF health insurance for informal sector workers in Kenya


Health insurance has positive impact on low-income households as it leads to lower out-of-pocket expenditures and improves access to healthcare.

Without health cover, the high cost of health care has devastating consequences for low-income households, including delaying or foregoing care or financing health emergencies with loans, savings or asset sales. Challenges in financing health care and low awareness of health issues are among main reasons why low-income populations in Kenya do not use health care services even when facilities are within their reach. Kenyan financial diaries show that 38% of poor households postpone treatment.

The National Hospital Insurance Fund (NHIF) in Kenya is one of the most advanced social health insurance schemes in Africa. Still, millions of Kenyans (especially those in the informal sector) have a low awareness of health insurance and use poor risk-management practices to cope with the financial impact of ill health.

Only about 20% of the population is covered by either social or private health insurance leaving around 35 million Kenyans, mostly low-income workers in the informal sector and their families, without a proper mechanism to finance their health needs. 


Our partnership with Financial Sector Deepening Trust (Kenya) paved the way for the ILO’s Impact Insurance Facility and ThinkWell to conduct a feasibility study exploring how the comprehensive NHIF health insurance package can be extended to more informal sector workers and their families.

Based on the feasibility study we propose a project to catalyse public-private partnerships, enabled by digital technology to increase access to NHIF health insurance through an agency distribution model, and promote better health and financial protection for informal workers and their families in Kenya. The Facility and FSDK continue to work on developing further activities that would implement key recommendations that follow from the feasibility study.


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