The Ministry of Health has rolled out a new Primary Health Care (PHC) financing model where payments to health facilities will now be based on the actual number of patients served, not insurance coverage, ensuring funds are allocated where they are needed most.
In a statement on Wednesday, March 5, the ministry described the shift as a major step toward Universal Health Coverage (UHC).
This new payment model is different from the National Health Insurance Fund (NHIF) model, where payments to health facilities were based on the patient's insurance status, meaning only insured individuals who had paid their premiums in advance received services.
Healthcare services were funded through insurance premiums paid by individuals. The old model often left out individuals who could not afford insurance premiums, creating financial barriers to accessing healthcare.
“This new approach will not only ensure that healthcare funds reach the right places but will also strengthen service delivery by prioritising patient needs over insurance status,” the ministry stated.
The new approach ensures that all patients receive care, with facilities reimbursed based on verified service data.
To ensure timely reimbursements, the government has reduced the claims processing time from 90 days to 30 days. Furthermore, all PHC payments will be sent directly to PHC-funded accounts to guarantee dedicated financing for essential healthcare services.
The ministry has now urged counties to strengthen Facility Improvement Fund (FIF) committees to enhance financial management and service delivery.
Further, the ministry has revealed that all primary healthcare services will be fully tax-funded, reinforcing the principle that healthcare is a fundamental right and not a privilege.
Fully tax-funded means that primary healthcare services under this model are entirely financed by taxes, ensuring greater accessibility, especially for those who previously faced financial barriers.
"With primary healthcare now fully tax-funded, no Kenyan will be locked out of essential services," Health Cabinet Secretary Deborah Barasa revealed on Wednesday.
These new changes come at a time when the ministry is trying to streamline the sector and deliver better services amid complaints from Kenyans that the sector is failing.
