Universal Health Coverage (UHC) plan by the Jubilee government stands as the most significant milestone towards revolutionising the health sector.

The feat has been achieved by increasing accessibility of critical health services and making them affordable to most Kenyans. Through the National Hospital Insurance Fund (NHIF), the government expanded the cover to cater for critical conditions that were earlier not catered for.

Services including dialysis, kidney transplant and chemotherapy are currently covered under NHIF. Millions of Kenyans from the low and medium-income brackets are now able to access the critical and life-prolonging medical services.

To strengthen UHC, the fund migrated from the manual system to a biometric registration platform. This move was to both curb fraudulent claims by unscrupulous medical facilities and to streamline the process of registration of members and lodging and settling claims.

NHIF data show approximately 10 million Kenyans are under this cover. At a glance, the numbers appear impressive. The flipside is alarming. Half of those registered are dormant. They are not active contributors.

This is attributed to the devastating effects of Covid-19 that led to massive job layoffs making it impossible for many self-employed members to pay. However, there is also the matter of contributory fatigue by members who rarely benefit from claims due to relatively robust health.

The dormancy poses two risks. By not contributing, the government lacks the revenue to settle claims. NHIF has expressed concern over a scenario it is paying Sh1 to claims for every Sh1 received from active members. The second risk is a rise in the financial burden at domestic level for poor families. Lack of a cover will force families to dig deeper into their pockets to cater for medication. This sinks households deeper into poverty.

To fully achieve the government’s objectives, including UHC, the insurer must be innovative. It must retain members already registered even as it reaches out to others not in the system. The surest way of attaining the two goals is through incentivising active members. This will make NHIF attractive for all.

Like other insurance firms, the fund operates under the broad principle of risk mitigation. However, the reality of half of the current members being dormant is an indicator that a new approach is needed to revamp its operations.

Introduction of attractive packages to entice Kenyans into enrolling might be a good start. One package is on rewarding members who faithfully contribute and never make claim.

Across the country, there are thousands of NHIF members who pay Sh6,000 annual fee but never use the cover. While this looks like an acceptable cost in risk mitigation, a struggling and cash-strapped Kenyan has a different feel. They will view this contribution as a ‘loss’; lost money that probably could have been put into a better use. Of course the sentiments would be different should there be a medical emergency that calls for use of the cover but there is none in this case.

If such contributors go for five years without ever having used the cover, they will likely start questioning the essence of remaining active contributors. Here, their hard-earned cash is merely money given away without returns. The contributors might deliberately default on payments or choose to channel the money elsewhere. At worst, they will be tempted to engage in crooked conduct and make fraudulent claims to ‘get something back’ from their ‘investments.’

NHIF can address this prevalent disgruntlement among low-income contributors. Members can be assured theirs is a worthy cause.  Rewarding contributors who never make a claim is a worthy incentive. Introducing an automated system where members with no claims get an automatic one-month free cover for each year they did not use the cover could be magic.

With such, NHIF gets multiple benefits. Kenyans join the scheme because they win whether they fall sick or not; cases of fraud become less and the government gets money effortlessly.

NHIF must become more innovative to incentivise members and contributors if the country is to achieve the objectives of UHC.