Arnold Osano is an Nguvu Change Leader with Nguvu Collective in Kenya, a 24-year-old young Kenyan, a resident of Kisumu County.
He has studied Development Studies with IT at Maseno University and I'm currently serving as the Executive Director of WeCare Youth Organization, a community-based and youth-led organisation in Western Kenya.
He is passionate about the realization of primary health care for all citizens.
He has a petition to Nguvu Collective to give Kenyans quality and affordable healthcare services.
Petition Link: https://www.change.org/p/give-kenyans-quality-and-affordable-healthcare-services
Question: How can Kenya effectively implement income-based premium contributions in its Social Health Insurance Fund (SHIF) to ensure equitable access, especially for the informal sector?
Answer: Approximately 83 per cent of Kenya’s workforce is in the informal sector, based on the 2023 Economic Survey by Kenya National Bureau of Statistics [KNBS], making sustainable, income-based contributions a challenge.
To ensure equitable access, Kenya should adopt a progressive contribution model, where the wealthier contribute more, while the government subsidises premiums for low-income earners.
Mobile money platforms, which are widely used in the informal sector, like M-Pesa and Airtel Money, can be used to estimate income levels and facilitate collections.
Community groups such as chamas and welfare associations can act as enrollment points and support compliance.
Targeted subsidies and risk-pooling, as seen in Thailand’s and Ghana’s UHC success, will be critical to ensuring no one is left behind while ensuring financial protection as is envisioned in the Bottom-Up Economic Transformation Agenda.
Question: What lessons can Kenya draw from Rwanda's Mutuelles de Santé regarding community engagement and performance-based incentives to enhance UHC implementation?
Answer: Rwanda's Mutuelles de Santé is one of Africa’s most successful community-based health insurance models, with a success rate of over 90 per cent insurance coverage through community trust and performance-based financing.
Kenya can draw multiple lessons from Rwanda’s Mutuelles de Santé, including decentralised enrollment and premium collection through local cooperatives, which improved public trust, confidence and compliance, performance-based financing (PBF) where facilities receive bonuses and other incentives for meeting quality and service delivery benchmarks and strong emphasis on community health workers (CHWs), who serve as liaisons between the health system and households.
Kenya is already replicating this by empowering community health volunteers (CHPs) through formal recruitment, training and pay structures and using facility-level health committees to monitor service delivery and enhance accountability.
Question: In transitioning from the National Health Insurance Fund (NHIF) to SHIF, how can Kenya ensure transparency and accountability to prevent the pitfalls?
Answer: NHIF faced consistent criticism over corruption, delayed reimbursements, and lack of transparency. To avoid repeating these issues, SHIF should implement open contracting and public disclosure of fund utilization, leveraging platforms like the Open Government Partnership (OGP).
It should also establish an independent oversight authority comprising civil society, professional bodies, and citizens to track operations, compliance and performance to ensure transparency and enhance accountability.
Citizens can also utilize existing digital platforms and tools such as the Action for Transparency [A4T] and the Uwajibikaji Platform to track performance, transactions and have the capability of reporting cases of fraud or non-compliance.
It should also adopt citizen scorecards and social audits at the facility level to give users a platform to evaluate service delivery and provide feedback that can improve service delivery.
Question: What strategies can Kenya adopt to strengthen primary healthcare as a cost-containment measure, drawing from international best practices?
Answer: Primary Health Care (PHC) is the backbone of UHC and a proven cost-containment strategy. The WHO recommends that countries allocate at least 30 per cent of health spending to PHC, and Kenya is also a signatory to the Abuja Declaration 2001, requiring member countries to allocate at least 15 per cent of their annual budgets to the health sector.
Kenya can scale up the Primary Healthcare Networks (PCNs) initiated under the Universal Health Coverage pilot in Kisumu, Machakos, Isiolo and Nyeri counties to improve the quality of health services, enhance resource sharing, enable comprehensive care and improve efficiency.
It can also train and deploy more CHPs, who provide frontline services and are key to early intervention and disease prevention, thereby reducing unnecessary hospital visits, adopt task-shifting strategies, where nurses and clinical officers handle non-complex cases, as done successfully in Ethiopia and Brazil, and ensure essential medicine availability at local facilities to prevent costly referrals.
A study by the World Bank in its report, Walking The Talk: Reimagining Primary Health Care after Covid-19, shows that investments in PHC can reduce overall health system costs by up to 40 per cent over time, improve health outcomes while contributing to economic growth and job creation.
Question: How can Kenya balance mandatory coverage with affordability to avoid overburdening low-income populations?
Answer: Mandatory health insurance ensures wide risk pooling, but it must be paired with smart subsidies and flexible contribution models. According to the Social Health Insurance Act, Kenyans will contribute 2.75 per cent of their gross income, but without exemptions or subsidies, this could harm the vulnerable households and individuals.
Recommendations
1. Identify and fully subsidise indigents through the Single Social Registry, which already covers over 1.2 million poor and vulnerable households. By automatically enrolling these households into SHIF and providing full or partial subsidies, the government will have ensured the progressive realization of the right to health without placing the burden on those least able to pay.
2. The government can leverage the Social Protection Bill 2025 by aligning SHIF contributions with social assistance transfers, as the Social Protection Bill proposes harmonization of cash transfers (e.g., Inua Jamii).
Part of these transfers could be earmarked to cover SHIF premiums, similar to how Ghana used its Livelihood Empowerment Against Poverty (LEAP) programme to support health insurance. This ensures that social assistance directly reduces healthcare vulnerability.
3. Allow flexible payment schedules for informal sector workers, including daily or weekly micro-contributions through mobile services.
4. Cap out-of-pocket expenditures for services not covered by SHIF to prevent catastrophic health spending, which currently affects 1.1 million Kenyan households annually.
5. Ensure benefits packages match contributions to sustain public trust, confidence and support. avoiding a situation where citizens pay but receive poor-quality services, leading to backlash
