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Table 2 Key milestones towards NHI in Kenya

From: Historical account of the national health insurance formulation in Kenya: experiences from the past decade

Period key activities/outputs
1965 Sessional paper no 10 on “African Socialism and its application in Kenya” which outlined plans to provide welfare on a large scale. Government waived KES 5.00 charged to people
1966 Creation of the NHIF through an act of parliament to replace the existing racially discriminative scheme by providing a contributory hospital based cover for all Kenyans aged over 18 years in formal employment and earning over Kshs 1,000.
1970 Failure of local services to offer satisfactory services led to transfer of services to central government but no extra fund to meet the extra costs
1972 Voluntary NHIF membership was introduced to bring on board the informal sector and those earning less than Kshs 1,000.
1986 Sessional paper No. 1 of 1986 on “Economic Management for renewed growth”. Outlining Government priorities relating to financing of health care services including strengthening of NHIF and introduction of cost sharing in public health facilities.
1989 The cost sharing policy introduced in the public health sector (user fees) to mobilize additional resources in the health sector, reduce excessive use of resources and improve the functioning of the referral system
1990 Review of NHIF contribution premium rates having stagnated at Kshs 20 since inception of the fund to offset the impact of inflation and raising health care costs and also to generate additional resources towards financing of health care services
temporary suspension of user fees
1992 Reintroduction of modest user fees
1994 Cabinet approved the Kenya Health Policy Framework a blue print for priorities in health care
Review of the NHIF from being a Government department within the ministry of health into a state corporation, through Act of parliament
November 2001 First national congress on quality improvement in health medical research and traditional medicine
President directed ministers to take action on measures to establish a mandatory NSHI for all Kenyans
delegates adopted a resolution to include “right to health in the constitution” and adopted a task force report on affordable health care which recommended the establishment of NSHIF
January 2002 Cabinet adopted a resolution for the establishment of NSHIF
May 2002 Minister of Health established an inter sectoral task force to prepare a national strategy and Draft bill expected to lead to the establishment of NSHIF with its members from government and private sector
A task force completed its work and submitted a strategy report and a bill to the minister
2003 Economic Recovery Strategy (ERS) for Wealth and Employment Creation (2003–2007) strategy aimed at transformation the existing NHIF into a NSHIF
June 2003 MoH approached GTZ/WHO for technical support with 6th expert mission form June 2003-June 2004 to support implementation of the scheme once passed by law
June 2003 1st Technical mission which reviewed strategy and draft bill which led to the draft sessional paper no 2 of 2004
August 2003 2nd mission which focused on the legal aspects of the NSHI bill-benefit package, provider systems, transition of NHIF-NSHIF
October 2003 3rd Mission that focused on the health insurance management and financial feasibility of the implementation
January 2004 4th mission which focused on the progress towards implementation change management process and implementation of the working group
April 2004 5th Mission which reviewed progress to formulate mile stones
June 2004 6th Mission on financial projections and trained Kenyans on financial simulations tool
9th Dec 2004 Debates in parliament and a bill was passed in but was not assented by the president on 31st Dec 2004