Public health challenges · 2026
Implications of Kenya's Enhanced Public Officers Medical Scheme on Equity in Strategic Purchasing and Progress Towards Universal Health Coverage.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Olpengs David, Moraa Diana, Mbuthia Boniface
Аннотация
BACKGROUND: Kenya transitioned its health financing from the National Health Insurance Fund (NHIF) to the Social Health Authority (SHA) in 2024. This model was designed to advance efficiency and equity, ultimately leading to universal health coverage (UHC). Shortly thereafter, the government introduced a parallel Enhanced Public Officers Medical Scheme Fund (POMSF), tailored to privilege public officers through dedicated funding and benefits. This article explores the implications of this targeted scheme on equity in strategic purchasing and the journey towards UHC.
METHODOLOGY: The article is a policy perspective grounded on document review of legislation, regulations, government documents and grey literature. Evidence was identified through targeted searches of PubMed, Google Scholar and Kenyan sources. Analysis was guided by the Strategic Purchasing Resource Centre for Africa (SPARC) and RESYST strategic purchasing frameworks and organized across governance, revenue mobilization, risk pooling, benefit design, provider contracting, provider payment, access protocols, financial protection and accountability. Comparative evidence from civil-servant and segmented insurance arrangements in Thailand, Tanzania and Indonesia was used.
FINDINGS: SHA is designed to support population coverage, cross-subsidization, standardized entitlements and primary healthcare-led access. POMSF, although administered through SHA, relies on ring-fenced public financing, a scheme-specific governance structure, enhanced benefits, separate contractual arrangements, negotiated tariffs and flexible access pathways for public officers. These features may improve financial protection and service responsiveness for beneficiaries but risk-fragmenting pools, weakening redistribution, creating unequal entitlements and generating competing provider incentives.
CONCLUSIONS: POMSF is not inherently incompatible with UHC, but its equity effects depend on how it is financed, governed and linked to SHA. Kenya should establish transparent financial links, common purchasing standards, harmonized tariffs and referral rules, integrated data and accountability systems, and periodic equity review. Without these safeguards, POMSF may entrench a two-tier system, weaken solidarity within health financing and Kenya's movement towards equitable UHC.
METHODOLOGY: The article is a policy perspective grounded on document review of legislation, regulations, government documents and grey literature. Evidence was identified through targeted searches of PubMed, Google Scholar and Kenyan sources. Analysis was guided by the Strategic Purchasing Resource Centre for Africa (SPARC) and RESYST strategic purchasing frameworks and organized across governance, revenue mobilization, risk pooling, benefit design, provider contracting, provider payment, access protocols, financial protection and accountability. Comparative evidence from civil-servant and segmented insurance arrangements in Thailand, Tanzania and Indonesia was used.
FINDINGS: SHA is designed to support population coverage, cross-subsidization, standardized entitlements and primary healthcare-led access. POMSF, although administered through SHA, relies on ring-fenced public financing, a scheme-specific governance structure, enhanced benefits, separate contractual arrangements, negotiated tariffs and flexible access pathways for public officers. These features may improve financial protection and service responsiveness for beneficiaries but risk-fragmenting pools, weakening redistribution, creating unequal entitlements and generating competing provider incentives.
CONCLUSIONS: POMSF is not inherently incompatible with UHC, but its equity effects depend on how it is financed, governed and linked to SHA. Kenya should establish transparent financial links, common purchasing standards, harmonized tariffs and referral rules, integrated data and accountability systems, and periodic equity review. Without these safeguards, POMSF may entrench a two-tier system, weaken solidarity within health financing and Kenya's movement towards equitable UHC.