STRATEGIC PLAN 2018-2022...His Excellency President Uhuru Kenyatta on 12th December 2017 announced...
70
Transcript of STRATEGIC PLAN 2018-2022...His Excellency President Uhuru Kenyatta on 12th December 2017 announced...
Towards Universal Health Coverage
STRATEGICPLAN
Pathway For Health Financing In Kenya
2018-2022
NHIF2018 - 2022
STRATEGIC PLAN
NHIF2018 - 2022
STRATEGIC PLAN
44
THEMETransformative and sustainable financing towards universal health coverage in Kenya .
VISIONWorld class Universal social health insurer .
MISSION
To contribute towards universal health coverage in the provision of affordable, accessible, sustainable and quality health insurance through strategic resource pooling and healthcare purchasing in collaboration with stakeholders .
CORE VALUES
• Customer Responsiveness• Ethics and Professionalism• Innovation and Creativity• Partnerships and Collaborations• Team Spirit• Corporate Social Sustainability
QUALITY POLICY STATEMENT
NHIF is committed to providing quality health insurance that is affordable, accessible and sustainable through the use of effective systems and procedures, so as to meet or exceed the customer needs and expectations.
NHIF is committed to comply with requirements and continually improve the effectiveness of the Quality Management System (ISO 9001).
QUALITY OBJECTIVES• Achieve and maintain a level of quality which enhances the Fund’s reputation with customers . • Ensure compliance with the NHIF Act and other relevant statutory and safety requirements• Endeavour to always maximise customer satisfaction through provision of Quality Services .
i
5
TABLE OF CONTENTS
ABBREVIATIONS AND ACRONYMS.....................................................................................ivSTATEMENT BY THE CHAIRPERSON, BOARD OF MANAGEMENT..................................................vFOREWORD BY THE CHIEF EXECUTIVE OFFICER...................................................................vEXECUTIVE SUMMARRY................................................................................................vi
CHAPTER ONE: INTRODUCTION...........................................................................1
1.1 Establishment and Mandate................................................................................11.2 Functions of NHIF............................................................................................11.3 Organizational Governance.................................................................................11.4 Role of National Hospital Insurance Fund (NHIF) in Kenya’s Development Agenda................21.5 Healthcare financing and the move towards Universal Health coverage.........................31.6 Emerging Issues and Challenges in the Health Sector....................................................51.7 Scope of Work and Methodology Used to Develop the Plan.........................................71.8 Organization of the Strategic Plan.......................................................................8
CHAPTER 2: SITUATION ANALYSIS.......................................................................10
2.1 Preamble.....................................................................................................102.2 Review of 2014 – 2018 Strategic Plan..................................................................102.3 The SWOT Analysis..........................................................................................162.4 Stakeholder Analysis........................................................................................16
CHAPTER 3: STRATEGIC FRAMEWORK.................................................................19
3.1 Introduction........................................................................................... ......193.2 Mandate......................................................................................................193.3 Core Functions..............................................................................................193.4 Vision Statement............................................................................................193.5 Mission........................................................................................................193.6 Core Value Statement ....................................................................................193.7 Value Proposition...........................................................................................213.8 Strategic Issues, Goals, Objectives, and Strategies...................................................223.8.1 Strategy Map................................................................................................22
CHAPTER 4: THE BALANCE SCORECARD 2018- 2022 ............................................25
4.1 Financial Perspective ................................................................................254.2 Customer Perspective ................................................................................274.3 Internal/Process Perspective.............................................................................294.4 Organizational Capacity...................................................................................30
CHAPTER 5: PLAN IMPLEMENTATION...................................................................32
5.1 Introduction.................................................................................................325.2 Implementation/Action Plan.............................................................................325.3 Organizational Structure and Human Capacity.........................................................325.4 Coordination Mechanism..................................................................................325.5 Accountability ...........................................................................................335.6 Risk and Risk Management................................................................................33
ii
66
CHAPTER 6: RESOURCE FLOWS........................................................................36
6.1 Resource Mobilization......................................................................................366.2 Budgetary Requirements...................................................................................36
CHAPTER 7: MONITORING, EVALUATION AND REPORTING........................................38
7.1 Preamble.....................................................................................................387.2 Strategies for Monitoring and Evaluation (M & E)...................................................387.3 Monitoring Tools............................................................................................387.4 Progress Reports............................................................................................397.5 Annual Review and End Term Evalution................................................................397.6 Linking M & E to Annual Performance Contracts and Appraisals.................................397.7 Monitoring & Evaluation Framwork.....................................................................397.8 The Monitoring & Evaluation Model.....................................................................41
Annex 1: Strategy Implementation (Action Plan) Matrices...................................42
iii
7
ABBREVIATIONS AND ACRONYMS
ARV Antiretroviral BOD Board of Directors COMESA Common Market for Eastern and Southern Africa EAC East African Community HCPs Health Care Providers HIV/AIDS Human Immune Virus HISP Health Insurance Subsidy Programme HPT Health Products and Technologies ICT Information and Communications Technology KHSSP Kenya Heath Sector Strategic and Investment Plan KMA Kenya Medical Association LDCs Least Developed Countries M&E Monitoring and Evaluation MoH Ministry of Health MDAs Ministries, Departments and Agencies MTP Medium Term Plan NCD Non Communicable Diseases NEMA National Environmental Management Agency NGOs Non-Governmental Organization NHIF National Hospital Insurance Fund OP Older Persons PESTEL Political, Economic, Social, Technological, Ecological and Legal PWSD Persons with Severe Disabilities SDGs Sustainable Development Goals SWOT Strength Weaknesses Opportunities Threats TB Tuberculosis UHC Universal Health Coverage
iviii
88
STATEMENT BY THE CHAIRPERSON, BOARD OF MANAGEMENT His Excellency President Uhuru Kenyatta on 12th December 2017 announced his development agenda dubbed the ‘Big Four’ to bolster economic growth for the period 2018-2022. The ‘big four’ comprises of; Universal Health Coverage, Manufacturing, Affordable Housing and Food Security. NHIF has been tapped as the catalyst to drive the Universal Health Coverage (UHC) agenda.
Health is fundamental to the growth of the nation; it enables citizens to fully participate in vocation, contribute meaningfully to societal growth and enable the country to effectively compete on the global stage. Through Universal Health Coverage (UHC), it is expected that all people and communities will be able to access promotive, preventive, curative, rehabilitative and palliative quality health services, while ensuring that they are not exposed to financial hardship due to catastrophic medical expenditure.
The Government’s Vision which is captured in the Constitution of Kenya and Development Blue print aspires to ensure that all Kenyans access quality and affordable healthcare services. The National Health Insurance cover is one of the critical vehicles that the Government will use to achieve its constitutional obligation. NHIF has therefore scaled up its role in the achievement of the UHC through the Strategic Plan 2018-2022. The Strategic Plan, has put in place measures to guarantee accessible, affordable and sustainable health insurance. Therefore, we call upon all the stakeholders to help us realize this goal.
(Mrs) HANNAH MURIITHI,EBSBOARD CHAIRPERSON
v
9
FOREWORD BY THE CHIEF EXECUTIVE OFFICER
It is acknowledged that the greatest measure of wealth in a country is the people’s health. Kenya has made tremendous progress in addressing pressing health priorities through the provisions of the Kenya Constitution 2010, Vision 2030 and the Big Four (4) Agenda. With the current economic environment, comprising high inflation rates and medical fees, the need for Universal Health Coverage has become more pronounced than ever before. NHIF has taken the cue and has put in place measures to play its role in achievement of Universal Health Coverage; the main goal being to provide affordable, accessible, sustainable and quality health care to all Kenyans.
In order to align the Fund’s goals with the Vision 2030 and the Kenya Health Policy 2014-2030 blue Prints, NHIF has developed a 5- phase roadmap in line with these government aspirations of achieving universal health coverage. The idea is to ensure that all Kenyans are covered taking into consideration lessons learnt from the pilot phase. Additionally, an analysis of the implementation of Strategic Plan 2014-2018 has provided critical lessons on issues of social health insurance. These lessons have provided a strong foundation for the development of the 2018-2022 Strategic Plan.
The goals and objectives of the 2018-2019 Strategic Plan are set around four the-matic areas:
1. Quality Health Insurance Coverage.2. Financial Base.3. Institutional Capacity.4. Stakeholder Alliances and Partnerships
The successful implementation of the Strategic Plan calls for mutual cooperation between NHIF and all its stakeholders. In this regard, NHIF commits to sensitize stakeholders on the strategic plan and provide relevant information. More so, NHIF will continuously monitor and evaluate the implementation of the Strategic Plan and initiate mitigations measures in response to any risks identified. The commitment for the achievement of the 2018-2022 Strategic Plan goals requires involvement of all players and it is my strong believe that the five year period aspirations will become a reality.
NICODEMUS ODONGOAg. CHIEF EXECUTIVE OFFICER
vi
1010
EXECUTIVE SUMMARY
This Strategic Plan (2018-2022) has enabled us to examine the contextual environment in which we operate; explore the factors and trends that affect the way we perform our core functions; seek to meet and fulfill our vision and mission and identify strategic issues which must be addressed. Arising from review of the relevant documents, workshops and stakeholder consultations, the vision, mission, core values, goals, objectives and strategies outlined here under were agreed upon.
Our Vision: A World Class Universal Social Health Insurer
Our mission: To contribute towards universal health coverage in the provision of affordable, accessible, sustainable and quality health insurance through strategic resource pooling and healthcare purchasing in collaboration with stakeholders.
Core Values:To accomplish our vision and mission, NHIF commits itself to observing the highest ideals of customer responsiveness, ethics and professionalism, team spirit, partnerships and collaborations, innovation and creativity and corporate social sustainability as it implements its strategic objectives and strategies. Four (4) objectives were identified to enable achievement of the vision and mission.
The objectives which are anchored on NHIF mandate are:i) Increase number of principal members from 7 million to 19 million by 2022ii) Enhance revenue inflow and its utilizationiii) Enhance compliance to good governanceiv) Enhance synergies in information and resource sharing with stakeholders and partners. In order to achieve the objectives and strategies, an Action Plan has been formulated which sets out the tools for monitoring, evaluation and reporting of the Plan’s implementation results. A comprehensive range of performance targets have been developed as a basis of operationalizing the Plan and shall form the basis of annual performance contracting targets.
vii
11
CHAPTER ONE: INTRODUCTION
1.1 Establishment and MandateThe National Hospital Insurance Fund (NHIF) is a state corporation established un-der the National Insurance Fund Act, number 9 of 1998. Prior to this legislative reform the Fund existed as a department under the Ministry of Health since 1966. The Fund is mandated to facilitate access to quality healthcare through strategic resource pooling and healthcare purchasing in collaboration with stakeholders. NHIF works to secure financial risk protection against the cost of healthcare services for all Kenyan residents through prudent financial management of resources contributed by members from both formal and Informal sector of the economy.
1.2 Functions of NHIFThe functions of NHIF as established in the Act No 9 of 1998 are:- i) Receive all contributions and other payments required by this Act to be made to the Fund; ii) Make payments out of the Fund to declared hospitals in accordance with the provisions of this Act; iii) In consultation with the Minister, to set the criteria for the declaration of hos-pitals and to declare such hospitals in accordance thereto for the purposes of this Act; iv) Regulate the contributions payable to the Fund and the benefits and other payments to be made out of the Fund; v) Protect the interests of contributors to the Fund; vi) Advise the Minister on the national policy to be followed with regard to nation-al health insurance and to implement all Government policies relating thereto; andvii) Perform such other functions as are conferred on it by this Act or by any other written law.
1.3 Organizational Governance The Fund’s governance and management structure is organized as per recommend-ed international best practice for Semi-Autonomous Insurance Funds. The Board of Management (BoM) is the governing Body of NHIF as set out in the NHIF Act.
It is a representative Board with members nominated from designated stakeholder organizations such as Federation of Kenya Employers, Central Organization of Trade Unions; Kenya National Union of Teachers and the Kenya Union of Post Primary Ed-ucation Teachers; Kenya Medical Association; faith-based healthcare organizations; and government representatives such as Principal Secretary in the Ministry respon-sible for Health; Principal Secretary to the Treasury; Principal Secretary/Director of Personnel Management; Director of Medical Services; and a chairman appointed by the President by virtue of his/her knowledge and experience in matters relating to insurance, financial management, economics, health or business administration.
1
The Chief Executive Officer shall be an ex-officio member of the Board and is the Board Secretary.
The BoM is responsible for the review and approval of policies and monitoring the functions of NHIF. The day to day management of the Fund is the responsibility of the Chief Executive Officer, assisted by Management Directors in charge of Opera-tions and Quality Assurance, Finance and Investment, Strategy, Planning and Mar-keting, Human Resource and Administration Directorates’. Internal Audit Directorate reports to the Chief Executive Officer though it is answerable to BoM on its core mandate. Corporation Secretary and head of legal services reports to the Chief Ex-ecutive Officer but also responsible to the board on corporate governance matters. Other departments that report directly to the Chief Executive Officer include ICT, Supply Chain Management, and Corporate Communications.
1.4 Role of National Hospital Insurance Fund (NHIF) in Kenya’s Development AgendaSocial Health insurance has been recognized in the Kenya Vision 2030 as one of the pillars for Kenya to achieve Universal Health Coverage. In this regard, the Govern-ment has been promoting reforms in the National Hospital Insurance Fund (NHIF) to make it one of the key drivers for achieving universal health coverage.
Since 2013, these reforms have included, structural changes at NHIF to make the institution more effective and responsive to customer needs; reviewing the contri-butions rates; expanding the benefit package to include out-patient cover and new packages related to addressing non-communicable conditions; and instituting strat-egies to enrol more members. It is estimated that NHIF contributes over 10% of all health expenditure in the Country.
NHIF has already initiated effective recruitment strategies to ensure constant growth of members in both the formal and informal sectors. As at the end of the FY 2017/18, total membership stood at 7.6 Million; this translates to an overall cover-age of 27.2 Million Kenyans (principal contributors and their dependants), implying that over 50% of Kenyans are covered by NHIF. The target during the 3rd Medium Term Plan (2018-2022) period is to achieve over 70% health insurance coverage.
The increased membership has seen the Fund inject over KShs.33 billion in the Health Sector with projections to reach over KShs.100 billion by end of the Medium Term Plan 3 (MTP 3) period. NHIF is also playing a major role in Social Health Pro-tection through the implementation of the insurance subsidy programme among the poor and vulnerable groups. In the FY 2016/17, NHIF with the support of the Na-tional Government provided insurance cover to 160,422 households under the Health Insurance Subsidy Programme (HISP) and 41,666 Older Persons and Persons with se-vere Disabilities (OP & PWSD).
2
13
It is expected that county governments will take the cue and replicate similar pro-grammes at the county level.
NHIF will continue to play its rightful role in the realization of the Kenya Vision 2030 goals particularly with regard to the health sector.
1.5 Healthcare financing and the move towards Universal Health coverageThe healthcare financing pillar of the health system plays a critical role in facili-tating access to affordable and quality healthcare and providing financial protection against catastrophic healthcare expenditure. The goal of progressive health financ-ing strategy is to facilitate ‘ensuring adequacy, efficiency and fairness in financing of health services in a manner that guarantees all citizens access to essential health services they require. Only through this shall the country be able to attain the quality health services needed for attaining the highest possible standard of health.
The goal is built around three targets, and three focus areas namely; mobiliza-tion of resources required to provide the essential health services for the citizens; maximization of efficiency and value for money in the management and utilization of available health resources; and ensuring equity in mobilization and allocation of health funds to guarantee fairness in use.
The financing strategy should aim to achieve these objectives through a strategic agenda that targets interventions in three areas: mobilization, allocation and utili-zation. The area of resource mobilization will focus on defining the different sources of funds for health and strategies to mobilize the same, with an emphasis on do-mestic sources. The area of resource allocation on the other hand will focus on how the mobilized resources will be managed, with an emphasis on ensuring pooling, while the area of resource utilization will focus on how the resources will be used to purchase the essential services that the population needs.
Universal Health Coverage (UHC) is currently a global development priority as elabo-rated in various development forums and agreements. The Sustainable Development Goals (SDG’s) that reflected on the global consensus on development priorities, give emphasis on the achievement of the universal health coverage. SDG number 3 deals with health and 3.8 specifically aims to Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all’.
On 12th December 2017, His Excellency President Uhuru Kenyatta announced his new plan, the ‘Big Four’, which will guide the development agenda of the coun-try in the period 2018-2022. It focuses on key basic needs that are critical in up-lifting the living standard of Kenyans which is on the path to becoming an upper middle-income country by 2030. Prioritized is affordable and decent housing, food and nutritional security, employment creation through manufacturing and affordable healthcare.
3
1414
These four areas are expected to bolster strong and inclusive economic growth.
Health insurance penetration in Kenya has been on the rise since 2013 and has reached relatively high levels compared to other countries in the region. Special ini-tiatives being implemented have contributed to the rise of Health Insurance Subsidy Programme and Linda Mama Programme (Free Maternity Service). The Scaling up of health insurance to all Kenyans and building of partnership and collaboration be-tween levels of government as well as working closely with the health service pro-viders in the private sectors is key in the realization of universal health coverage.
Many medium and low income counties including Kenya are reforming and reorganiz-ing their health systems to achieve UHC as part of their national development goals. Special focus is being given to reforming and strengthening the health care financing pillar among the other pillars which are all essential for the achievement of UHC.
The Government of Kenya is implementing the social health insurance through NHIF as the main mechanism of demand side healthcare financing and risk pooling to-wards achieving UHC. Globally, social health insurance schemes have unique char-acteristics which are relevant to the enhancement of UHC and are incorporated in this strategy:
The Constitution of Kenya 2010 provides that every person has a right to the highest attainable standard of health. It further stipulates that the State shall provide ap-propriate social security to persons who are unable to support themselves and their dependants. The Constitution introduces a devolved system of County Government to enhance access to services by all Kenyans, especially those in rural and hard-to-reach areas. The Constitution singles out health care for specific groups such as children and persons living with disabilities while the Kenya Health Policy seeks to make the right to health by all Kenyans a reality (MoH, 2012).
Kenya Vision 2030 is the Country’s development blueprint covering the period be-tween 2008 and 2030. It aims at transforming Kenya into a newly industrializing, middle-income Country providing a high quality life to all its citizens by the year 2030. The blueprint is anchored on three pillars: social, economic, and political.
Kenya’s Health sector thus provides one of the most important components for ad-dressing issues of equity and the broader national socio-economic agenda in line with the aspirations of the social pillar of the Kenya Vision 2030. The sector’s goal is, “to attain equitable, affordable, accessible and quality health care for all Kenyan citizens” and thereby, reduce health inequalities while also reversing the downward trend that has been seen in health-related outcome and impact indicators. There-fore, the government intends to achieve the Universal Health Coverage by 2022.
4
1.6 Emerging Issues and Challenges in the Health Sector The health sector is guided by relevant provisions of the Constitution of Kenya 2010, among which is the “right to the highest attainable standard of health and the right to basic nutrition”. The health sector is also aware that the devolution of gov-ernance requires properly designed systems of fiscal management; evidence based planning, effective human resource planning, proper and effective coordination, po-litical goodwill and selfless leadership to ensure efficient and effective service deliv-ery through the devolved governments. Some of the areas where the sector faces challenges include:
a) Service delivery:i) Communicable Conditions; Communicable diseases account for the highest proportion of disease burden in the sector. ii) Non-Communicable Conditions; Non-communicable diseases (NCDs) such as hypertension, heart disease, diabetes, cancer and substance abuse continue to exert pressure on the health systems. There is also an emerging trend of comorbidities between these NCDs and HIV. iii) Maternal and Child Health and Nutrition; Inadequate emergency services for delivery, under-utilization of existing antenatal services and inadequate skills and competences of health workers. b) Human Resources for Health:The sector still faces challenges of skewed distribution of skilled health workers with some areas of the country facing significant gaps while others have optimum/surplus numbers. Increased industrial unrest among various cadres of healthcare workers agitating for better working conditions and terms ofemployment has posed a serious challenge in service delivery.
c) Health care Financing:Key challenges in healthcare financing include:i) Low total funding of healthcare in the country (7% of Total Government Budget against Abuja target of 15%).See figure 3.ii) Inefficiencies in the use of available funds (both technical and allocative inef-ficiencies). In the case of insurance schemes, benefit utilization management has been weak.iii) Leakages in the flow of healthcare funds of over 30% (As per various public expenditure tracking surveys)iv) Multiple fragmented health insurance pools both at national, county, donor and private sector levelsv) Low levels of health insurance coverage (about 17% coverage). This means that a significant proportion of Kenya’s population do not contribute towards the insur-ance fund. vi) Inadequate funding for research and development for the health sector since independence, there have been multiple initiatives to reform the healthcare financ-ing system in Kenya and to address the challenges mentioned above.
5
d) Health Products and Technologies (HPT): Inadequate budgetary provision for the procurement and distribution of supplies to public health facilities.
e) Health Infrastructure: There is inadequate infrastructure and skewed distribution of available infrastruc-ture within the sector with a strong bias towards the urban areas. There also exists obsolete health equipment that requires replacement. To address this challenge the GoK in 2015-2017 implemented the Managed Equipment Service (MES) project that upgraded medical equipment for diagnosis and treatment of various medical condi-tions in 2 hospitals in each of the 47 counties.
f) Leadership and governance:i. There is weak multi-sectoral coordination in the sector particularly on devolu-tion and Human resource management. ii. Lack of a decentralized trade union, for health workers, to adapt the constitu-tional requirement to enter into a recognition agreement with county governments.iii. Failure to adhere to set standards and regulations has contributed to counterfeit drugs entering the Kenyan market.iv. Weak regulation and coordination of conventional and traditional medicine. v. Ineffective multi-sectoral coordination of nutrition programmes in Ministries, Counties, Departments and Agencies.
g) Health research and development coordination: There is ineffective coordination of the various organizations conducting health re-search in the country coupled with limited accountability.
h) Healthcare quality and accreditation:Healthcare quality is generally low across public and private healthcare facilities as measured by the MOH standards & Norms and the KQMH system. There is large variability of service quality within and between healthcare providers. Other than the first registration by the various regulatory councils, there is no nationally agreed accreditation system of health care providers and NHIF was compelled by circum-stances to play this role. The current categorization of healthcare providers was mainly developed for public sector providers. There has been ineffective coordina-tion between the various regulatory councils/boards in ensuring quality (and hence effectiveness and efficiency of health care). It is nearly impossible to do accurate costing of healthcare services as the quality is unknown. The newly passed Health Act will go a long way in addressing these critical gaps.
i) Climate change: Climate change continues to affect human health due to weather variables, indi-rectly through natural systems such as disease vectors and human systems such as under nutrition there by affecting human health and well-being.
6
17
1.7 Scope of Work and Methodology Used to Develop the Plan The Strategic Plan formulation has enabled us to examine the contextual environ-ment in which we operate; explore the factors and trends that affect the way we perform our core functions; seek to meet and fulfill our vision and mission; frame strategic issues which must be addressed; and develop and implement strategies and action programmes for attaining the predetermined objectives. The formulation and implementation of this roadmap is expected to positively impact the Fund and its constituents.
The process of developing this Plan relied heavily on an extensive review of the rel-evant documents including Vision 2030, First MTP (2008-2012), MTP II, MTP III Draft Health Sector, Mid Term Review of the Kenya Health Sector Strategic and Investment Plan, Kenya Health Policy (KHP 2014 – 2030), Kenya Health Sector Strategic and Investment Plan (KHSSP, July 2014 - June 2018) and the Constitution among other documents in the Health Sector.
The planning team used a self-administered questionnaire to collect primary data from all NHIF Staff. The questionnaire elicited information on past performance, current status and the projected operating environment of the Fund. More informa-tion was collected through key informant interviews using a questionnaire/interview guide. The pertinent data was analyzed to identify and prioritize the strengths, weaknesses, opportunities and threats (challenges) facing the Fund. This further culminated in the identification of strategic issues and development of the strategic framework in terms of the vision, mission, core values, objectives and strategies.
Finally, a strategy planning workshop was held in November 2017 with Senior Man-agement. The workshop culminated in the formulation of the Vision and Mission statements as well as agreeing on the core values. On the basis of the revised mission, vision and core values, objectives were developed and relevant strategies crafted. There was also a consultative meeting held in November 2017 with key stakeholders including the Kenya Medical Association (KMA) and COTU among others.
Subsequently, their strategic insights have been incorporated into the Plan. The views of the NHIF Board of Directors were received at different stages of the for-mulation that is, in December 2017, March 2018 and finally in July 2018 when they discussed and approved the Strategic Plan. The Strategic Plan was discussed with the Cabinet Secretary Ministry of Health in October 2018.
7
1818
1.8 Organization of the Strategic PlanThe Plan is organized around Seven Chapters. Chapter 1 sets out the introduction and background giving the justification for developing the Plan. Chapter 2 outlines the Situation Analysis within which is a review of the 2014-2018 Strategic Plan, SWOT and Stakeholder analysis. The Strategic Framework is summarized in Chapter 3. Chapter 4 is a breakdown on the Balanced Score Card. Chapter 5 focuses on how the Plan will be implemented while Chapter 6 presents the resource flows, revenue and expenditure projections. The Final Chapter (Chapter 7) summarizes the moni-toring and evaluation mechanism of the Plan.
8
20
CHAPTER 2: SITUATION ANALYSIS
2.1 Preamble
This Chapter presents a summary of the achievements, challenges and lessons learnt during the implementation of the 2014 -2018 Strategic Plan. It also covers past per-formance review in terms of staff perceptions on NHIF Performance and the exter-nal and competitor analysis. These analyses lead to identification of key strengths, weaknesses, opportunities, threats (SWOT) as well as a presentation of the stake-holder analysis matrix.
2.2 Review of 2014 – 2018 Strategic Plan
The previous five-year strategic plan was implemented from 2014 to 2018. The plan had been developed to enable the Fund to position itself as a “Hunter Organiza-tion” with the overall objective of ensuring increased number of Kenyans accessing quality and equitable health care through the health insurance. To ensure achieve-ment of the set goals and objectives, emphasis was laid on reengineering the Fund’s processes to improve service delivery, quality management, increase access, poli-cy reviews & implementation, review of the contributions, benefit maximization, ICT capacity enhancement and overall efficiency gains to reduce the administrative costs. The key thematic areas for the Strategic Period were;
Enhancing customer relationships Improving operating quality & efficiency and Enhancing channels & offerings .
The Strategic plan majorly focussed on expansion of coverage in the informal sec-tor and those of the indigent population through government support; stakeholder engagement and public and private partnerships strengthening to ensure the Fund worked in harmony with stakeholders.
End of the period evaluation of the plan established that best implementation sta-tus of planned activities was observed under increasing coverage where principal Members increased from 5.4M in 2014/15 to 7.6M in 2017/18; as well as the review of benefit packages to include outpatient and special packages. Further, key im-plementation gaps were observed in delayed development of planned policies and development of information system to related initiatives like e-claims, CRM system and the e-procurement. The evaluation report provided key lessons in the devel-opment of the 2018-2022 Strategic Plan. The table below summarises the achieve-ments, challenges and lessons learnt during the Strategic Period 2014-2018;
10
21
The
tabl
e be
low
sum
mar
ises
the
ach
ieve
men
ts,
chal
leng
es a
nd l
esso
ns l
earn
t du
ring
the
Str
ateg
ic P
erio
d 20
14-2
018
Tabl
e 2.
1 Su
mm
ary
of t
he 2
014-
2018
Str
ateg
ic P
lan
Ach
ieve
men
ts
SP 2
014-
18 A
CHIE
VEM
ENTS
SP 2
014-
18 C
HA
LLEN
GES
LESS
ON
S LE
ARN
T &
WAY
FO
RWA
RD
Reve
nue
Gro
wth
fro
m 1
5B i
n 20
14 t
o 47
B in
201
8Re
sist
ance
to
the
revi
ew o
f co
ntri
buti
on r
ates
by
Sta
keho
lder
sSt
akeh
olde
r in
volv
emen
t is
cri
tica
l
Incr
ease
in
payo
ut r
atio
fro
m 6
2% i
n 20
14 t
o 85
% in
201
8Po
rtab
ility
of
bene
fits
Whe
n de
sign
ing
prep
aym
ent
mec
hani
sm i
t is
im
port
ant
to
cons
ider
por
tabi
lity
of b
enefi
ts
Impr
oved
acc
ess
to h
ealt
hcar
e se
rvic
es;
num
ber
of
accr
edit
ed H
CPs
incr
ease
d fr
om 2
,800
in
2014
to
7,58
4 in
201
8
Enha
ncem
ent
of c
usto
mer
rel
atio
nshi
ps t
hrou
gh t
he
roll
out
of t
he H
ISP
and
OP&
PWD
insu
ranc
e su
bsid
y pr
ogra
ms
as w
ell
as t
he d
evel
opm
ent
of m
icro
sec
tor
stra
tegi
es
Leng
thy
clai
m p
roce
ss;
this
was
add
ress
ed t
hrou
gh
init
iati
ng r
evie
w a
nd r
eeng
inee
ring
of
the
clai
ms
proc
ess
Invo
lvem
ent
of H
ealt
h Ca
re P
rovi
ders
on
deve
lopm
ent
of p
olic
ies
that
are
exp
ecte
d to
im
plem
ent
Deve
lopm
ent
of k
ey p
olic
ies
like
corp
orat
e go
v -er
nanc
e an
d pe
rfor
man
ce c
ontr
act
that
enh
ance
d co
rpor
ate
gove
rnan
ce f
ram
ewor
k
Inad
equa
te I
CT s
yste
m c
ontr
ols;
thi
s w
as a
ddre
ssed
th
roug
h de
velo
pmen
t of
an
ICT
Stra
tegy
Ther
e is
nee
d to
des
ign
faci
lity-
spec
ific
com
mun
icat
ion
on c
ontr
acts
, be
nefit
s an
d im
plem
enta
tion
of
polic
ies
Rest
ruct
urin
g of
the
org
aniz
atio
n w
hich
enh
ance
d sy
nerg
y in
ope
rati
ons
Inci
denc
es o
f fr
aud;
thi
s w
as a
ddre
ssed
thr
ough
st
reng
then
ing
cont
rols
: on
e am
ong
them
int
rodu
ctio
n of
pre
-aut
hori
zati
on o
f so
me
bene
fits
The
Fund
req
uire
s m
ore
cons
ulta
tive
sta
keho
lder
eng
age -
men
ts t
o en
sure
con
tinu
ous
flow
of
info
rmat
ion
Mai
ntai
ning
ISO
900
1:20
08 Q
MS
cert
ifica
tion
sIn
suffi
cien
t re
view
of
inst
itut
iona
l fr
amew
ork
on
gran
ting
pre
auth
oriz
atio
n le
tter
s; t
he f
ram
ewor
k w
as r
evie
wed
and
dec
entr
aliz
ed
The
Info
rmal
sec
tor
is n
ot f
ully
exp
loit
ed a
nd t
here
is
need
for
mor
e fo
cuse
d st
rate
gies
for
the
sec
tor.
Impr
oved
bra
nd i
ndex
Inad
equa
te i
nter
nal
com
mun
icat
ion;
the
Fun
d ha
s en
hanc
ed t
he i
nter
nal
chan
nels
of
com
mun
icat
ion
Ther
e w
ere
conc
erns
by
Stak
ehol
ders
on
the
crit
eria
use
d to
det
erm
ine
indi
gent
s in
the
HIS
P sc
hem
es.
The
Fund
is
wor
king
clo
sely
wit
h th
e co
unty
gov
ernm
ent
Enha
nced
sta
ff t
rain
ing.
Syst
em b
reak
dow
n at
the
HCP
s le
vel;
thi
s ha
s be
en
addr
esse
d th
roug
h en
hanc
emen
t of
the
ban
dwid
thEn
hanc
emen
t of
the
HIS
P
Casc
adin
g of
the
Nat
iona
l pe
rfor
man
ce c
ontr
acti
ng
(PC)
.In
adeq
uate
sta
ff o
rien
tati
on;
curr
entl
y th
ere
is a
ro
bust
ind
ucti
on p
rogr
amm
e in
pla
cePe
rfor
man
ce c
ontr
act
need
to
be c
asca
ded
earl
ier
in t
he
year
and
the
sta
ff w
ell
sens
itiz
ed.
11
2222
Issu
es/d
evel
opm
ents
tha
t ar
e lik
ely
to i
mpa
ct o
n N
HIF
cap
acit
y to
ach
ieve
its
ob
ject
ives
.
Effec
ts o
f th
e ch
ange
s pr
esen
t in
ter
ms
of o
ppor
-tu
niti
es a
nd t
hrea
ts t
o N
HIF
Dim
ensi
onG
loba
llyRe
gion
ally
Nat
iona
llyO
ppor
tuni
ties
Thre
ats
(Cha
lleng
es)
Polit
ical
/ L
egal
Fo
rces
• St
rong
glo
bal
supp
ort
for
coun
trie
s to
m
ove
tow
ards
uni
-ve
rsal
hea
lth
cove
r-ag
e as
evi
denc
ed b
y;
Wor
ld h
ealt
h re
port
20
12/2
013,
Afr
ica
min
iste
rs f
or h
ealt
h 20
12,
UN
res
olut
ion
2012
, 66
th w
orld
he
alth
ass
embl
y 20
13,
and
SDG
s.
• Su
ppor
tive
pol
icy
and
lega
l fr
amew
ork
for
univ
ersa
l he
alth
co
vera
ge
• St
rong
dev
elop
men
t pa
rtne
r su
ppor
t fo
r U
HC
and
regi
onal
ne
twor
ks s
uch
as
Join
t le
arni
ng n
et-
wor
ks (
JLN
) fo
r U
HC
• Th
reat
of
polit
ical
in
stab
ility
and
con
-fli
ct d
isru
ptin
g th
e he
alth
car
e sy
stem
le
adin
g to
dis
ease
an
d in
jury
• Su
ppor
tive
pol
icy
and
lega
l fr
amew
ork
for
univ
ersa
l he
alth
co
vera
ge•
Stro
ng d
evel
opm
ent
part
ner
supp
ort
for
UH
C an
d re
gion
al
netw
orks
suc
h as
Jo
int
lear
ning
net
-w
orks
(JL
N)
for
UH
C
• Su
ppor
tive
pol
icy
and
lega
l fr
ame-
wor
k fo
r un
iver
sal
heal
th c
over
age
• Cu
rren
t go
vern
men
t su
ppor
t fo
r U
HC
as e
vide
nced
in
draf
t he
alth
care
fin
anci
ng p
olic
y, K
enya
hea
lth
polic
y fr
amew
ork
2012
/203
0, v
isio
n 20
30,
curr
ent
Nat
iona
l he
alth
str
ateg
ic
and
inve
stm
ent
plan
IV
• Co
nsti
tuti
onal
man
date
to
prov
ide
heal
thca
re o
f th
e hi
ghes
t po
ssib
le
qual
ity
• St
rong
dev
elop
men
t pa
rtne
r su
ppor
t fo
r U
HC
and
regi
onal
net
wor
ks s
uch
as J
oint
lea
rnin
g ne
twor
ks (
JLN
) fo
r U
HC.
• In
crea
sing
foc
us o
n co
nclu
ding
the
Ke
nya
heal
thca
re fi
nanc
ing
stra
tegy
as
a m
eans
to
achi
eve
univ
ersa
l he
alth
cov
erag
e.
• Th
reat
of
polit
ical
ins
tabi
lity
and
confl
ict
disr
upti
ng t
he h
ealt
h ca
re
syst
em a
nd l
eadi
ng t
o di
seas
e an
d in
jury
.
• Co
nclu
sion
of
the
new
hea
lth
act
pend
ing
effec
tive
dat
e. T
his
has
crea
ted
new
reg
ulat
ory
bodi
es a
nd
defin
ed t
he r
ole
and
inte
ract
ion
of
acto
rs i
n th
e he
alth
sys
tem
s.
• So
cial
hea
lth
insu
ranc
e re
c-og
nize
d as
a k
ey p
illar
for
Ke
nya
to a
chie
ve U
HC.
• De
volv
ed h
ealt
h sy
stem
ha
s in
crea
sed
visi
bilit
y an
d ac
coun
tabi
lity
for
heal
th
deve
lopm
ent.
Cou
ntie
s ar
e pu
shin
g to
inc
reas
e he
alth
ca
re fi
nanc
ing
cove
rage
for
th
eir
staff
and
pop
ulat
ion
• Re
cent
im
prov
emen
t in
th
e su
pply
of
heal
th c
are
serv
ices
as
evid
ence
d by
; in
fras
truc
tura
l im
-pr
ovem
ent
unde
r th
e M
ES
proj
ect,
gre
ater
pri
vate
se
ctor
inv
estm
ent
incl
udin
g in
tern
atio
nal
inve
stor
s,
grow
ing
cons
olid
atio
n of
fa
cilit
ies
into
mor
e re
liabl
e ne
twor
ks.
• St
rong
pol
itic
al w
ill t
o re
form
NH
IF a
nd p
riva
te
heal
th i
nsur
ance
mar
ket
to
achi
eve
UH
C.
• Th
e ne
w h
ealt
h ac
t re
c-og
nize
s th
e im
port
ance
of
heal
th c
are
finan
cing
and
re
cogn
izes
the
rol
e of
dif
-fe
rent
act
ors
in h
ealt
hcar
e fin
anci
ng.
NH
IF r
ecog
nize
d as
the
pri
mar
y ve
hicl
e fo
r so
cial
hea
lth
finan
cing
.
• N
HIF
has
roo
m t
o ex
pand
co
vera
ge w
ith
min
imal
co
mpe
titi
on.
• H
ealt
hcar
e is
de-
volv
ed t
o co
unti
es
that
hav
e bo
th l
egal
an
d fin
anci
al m
anda
te
to p
lan
for,
finan
ce
and
deliv
er c
are.
N
HIF
has
to
enga
ge
coun
ties
and
neg
oti -
ate
thei
r ro
le
• Re
orga
niza
tion
, co
nsol
idat
ion
and
form
atio
n of
new
st
atut
ory
regu
lato
ry
bodi
es i
n he
alth
will
im
pact
the
rol
e an
d fu
ncti
ons
of N
HIF.
Tabl
e 2.
2 N
HIF
PES
TEL
Ana
lysi
s
12
23
Issu
es/d
evel
opm
ents
tha
t ar
e lik
ely
to i
mpa
ct o
n N
HIF
cap
acit
y to
ach
ieve
it
s ob
ject
ives
.
Effec
ts o
f th
e ch
ange
s pr
esen
t in
ter
ms
of o
ppor
tuni
-ti
es a
nd t
hrea
ts t
o N
HIF
Dim
ensi
onG
loba
llyRe
gion
ally
Nat
iona
llyO
ppor
tuni
ties
Thre
ats
(Cha
lleng
es)
Econ
omic
For
ces
• G
row
ing
dem
and
for
high
qua
lity
care
fr
om a
n ex
pand
ing
mid
dle
clas
s.
• In
crea
sing
hea
lth-
care
cos
ts d
rive
n by
; in
crea
sing
co
nsum
er
expe
cta-
tion
s, n
ew t
echn
ol-
ogie
s, p
redo
min
ance
of
im
port
ed t
ech-
nolo
gies
, co
rrup
tion
ab
use
and
incr
eas-
ing
hum
an r
esou
rce
cost
s
• Ep
idem
iolo
gic
tran
siti
on f
rom
re
lati
vely
che
aper
co
mm
unic
able
to
non-
com
mun
icab
le
dise
ase
whi
ch a
re
long
ter
m a
nd m
ore
cost
ly.
In t
he t
rans
i -ti
on p
hase
the
re i
s a
doub
le e
pide
mic
of
bot
h co
mm
unic
a-bl
e an
d no
n-co
mm
u-ni
cabl
e di
seas
es.
• Ex
tens
ive
focu
s on
exp
ensi
ve,
late
cu
rati
ve/a
cute
se
rvic
es a
s op
pose
d to
foc
usin
g on
the
m
ore
cost
-eff
ecti
ve
dise
ase
prev
enti
on
and
heal
th p
rom
o-ti
on.
• G
row
ing
dem
and
for
high
qua
lity
care
fr
om a
n ex
pand
ing
mid
dle
clas
s.
• In
crea
sing
hea
lthc
are
cost
s dr
iven
by;
in
crea
sing
con
sum
-er
ex
pect
atio
ns,
new
tec
hnol
ogie
s,
pred
omin
ance
of
im-
port
ed t
echn
olog
ies,
co
rrup
tion
abu
se a
nd
incr
easi
ng h
uman
re
sour
ce c
osts
• Ep
idem
iolo
gic
tran
si-
tion
fro
m r
elat
ivel
y ch
eape
r co
mm
uni-
cabl
e to
non
-com
-m
unic
able
dis
ease
w
hich
are
lon
g te
rm
and
mor
e co
stly
. In
th
e tr
ansi
tion
pha
se
we
have
a d
oubl
e ep
idem
ic o
f bo
th
com
mun
icab
le a
nd
non-
com
mun
icab
le
dise
ases
.
• Ex
tens
ive
focu
s on
exp
ensi
ve,
late
cu
rati
ve/a
cute
ser
-vi
ces
as o
ppos
ed t
o fo
cusi
ng o
n th
e m
ore
cost
-eff
ecti
ve d
isea
se
prev
enti
on a
nd h
ealt
h pr
omot
ion.
• G
row
ing
dem
and
for
high
qua
lity
care
fro
m a
n ex
pand
ing
mid
dle
clas
s.
• Ke
nya’
s po
siti
on a
s hu
b fo
r in
vest
men
ts a
nd h
uman
itar
ian
acti
viti
es h
as l
ed t
o an
inc
reas
e in
its
exp
atri
ate
popu
lati
on t
hat
dem
ands
a w
orld
cla
ss h
ealt
h-ca
re s
ervi
ce
• Si
gnifi
cant
ent
ry o
f ne
w p
laye
rs
in t
he s
ervi
ce d
eliv
ery,
hea
lth -
care
fina
ncin
g, h
ealt
hcar
e te
chno
logy
and
com
mod
itie
s m
arke
ts w
ill l
ead
to c
hang
es i
n th
e he
alth
care
val
ue c
hain
tha
t N
HIF
has
to
alig
n it
self
to.
• In
crea
sing
hea
lthc
are
cost
s dr
iven
by;
inc
reas
ing
cons
umer
ex
pect
atio
ns,
new
tec
hnol
ogie
s,
pred
omin
ance
of
impo
rted
tec
h-no
logi
es,
corr
upti
on a
buse
and
in
crea
sing
hum
an r
esou
rce
cost
s
• Ep
idem
iolo
gic
tran
siti
on f
rom
re
lati
vely
che
aper
com
mun
icab
le
to n
on-c
omm
unic
able
dis
ease
w
hich
are
lon
g te
rm a
nd m
ore
cost
ly.
In t
he t
rans
itio
n ph
ase
we
have
a d
oubl
e ep
idem
ic
of b
oth
com
mun
icab
le a
nd
non-
com
mun
icab
le d
isea
ses.
• Ex
tens
ive
focu
s on
exp
ensi
ve,
late
cur
ativ
e/ac
ute
serv
ices
as
opp
osed
to
focu
sing
on
the
mor
e co
st-e
ffec
tive
dis
ease
pre
-ve
ntio
n an
d he
alth
pro
mot
ion.
• In
crea
sing
bas
e of
em
-pl
oyed
and
sel
f-em
-pl
oyed
fro
m w
hich
N
HIF
can
rec
eive
co
ntri
buti
ons
• G
radu
al f
orm
aliz
atio
n of
Ken
ya’s
eco
nom
y in
clud
ing
the
use
of
mob
ile m
oney
mak
ing
colle
ctio
n of
fun
ds
chea
per
• In
crea
sing
aw
are -
ness
on
the
gene
ral
popu
lati
on o
n th
e im
port
ance
of
man
-ag
ing
heal
thca
re r
isks
th
roug
h ri
sk p
oolin
g an
d ot
her
finan
cing
m
echa
nism
s.
• In
crea
sed
tech
nica
l re
sour
ces
and
fund
ing
from
don
ors
and
gov -
ernm
ent
tow
ards
UH
C
• Si
gnifi
cant
dia
spor
a po
pula
tion
wit
h si
gnif
-ic
ant
rem
itta
nces
.
• U
phea
vals
in
the
hum
an
reso
urce
s fo
r he
alth
mar
ket
in
Keny
a fo
r ex
ampl
e, f
requ
ent
indu
stri
al a
ctio
ns,
disp
utes
wit
h co
unty
gov
ernm
ents
, m
al-d
istr
i-bu
tion
of
heal
thca
re w
orke
rs,
skill
s ga
ps i
n ce
rtai
n es
sent
ial
spec
ialis
ts s
ervi
ces
suc
h as
de
ntis
ts,
anae
sthe
tist
s an
d em
erge
ncy
med
icin
e
• Es
cala
ting
hea
lthc
are
cost
s pa
rtic
ular
ly f
or h
ospi
tal
base
d ca
re
• In
crea
sing
bar
gain
ing
pow
er
of h
ospi
tals
due
to
bett
er
orga
niza
tion
int
o as
soci
atio
ns
and
cons
olid
atio
n of
hea
lthc
are
busi
ness
thr
ough
loc
al a
nd
inte
rnat
iona
l in
vest
ors
• De
man
d fo
r br
oade
r be
nefit
s an
d hi
gher
rei
mbu
rsem
ent
from
an
inc
reas
ingl
y kn
owle
dgea
ble
clie
ntel
e
• Po
or a
nd a
ntag
onis
tic
rela
tion
-sh
ip b
etw
een
NH
IF a
nd c
riti
cal
part
s of
the
hea
lthc
are
valu
e ch
ain
has
resu
lted
in
serv
ice
prov
ider
s ch
argi
ng a
pre
miu
m
to N
HIF.
• W
eak
cont
ract
ing
betw
een
NH
IF a
nd p
rovi
ders
exp
osin
g N
HIF
to
loss
es a
nd p
oor
valu
e fo
r m
oney
.
• G
row
ing
com
mun
ity
and
priv
ate
sect
or m
icro
-ins
uran
ce s
chem
es
offer
a p
oten
tial
thr
eat/
alte
r-na
tive
to
an N
HIF
cov
er
13
2424
Issu
es/d
evel
opm
ents
tha
t ar
e lik
ely
to i
mpa
ct o
n N
HIF
cap
acit
y to
ach
ieve
it
s ob
ject
ives
.
Effec
ts o
f th
e ch
ange
s pr
esen
t in
ter
ms
of o
ppor
tuni
-ti
es a
nd t
hrea
ts t
o N
HIF
Dim
ensi
onG
loba
llyRe
gion
ally
Nat
iona
llyO
ppor
tuni
ties
Thre
ats
(Cha
lleng
es)
Soci
al-c
ultu
ral
Forc
es•
Incr
easi
ng g
loba
l-iz
atio
n an
d gl
obal
m
obili
ty m
eans
di
seas
es k
now
no
boun
dari
es.
• • Yo
unge
r po
pula
tion
th
at i
s m
ore
will
ing
to a
ccep
t ne
wer
te
chno
logi
es• •
Brea
kdow
n of
soc
ial
supp
ort
stru
ctur
es
such
as
trad
itio
nal
fam
ily a
nd m
igra
-ti
on a
re l
eadi
ng t
o in
crea
se i
n st
ress
an
d hi
gh r
isk
heal
th
beha
viou
r.
• In
crea
sing
glo
baliz
a -ti
on a
nd g
loba
l m
o-bi
lity
mea
ns d
isea
ses
know
no
boun
dari
es.
• • Yo
unge
r po
pula
tion
th
at i
s m
ore
will
ing
to a
ccep
t ne
wer
te
chno
logi
es• • •
Brea
kdow
n of
soc
ial
supp
ort
stru
ctur
es,
trad
itio
nal
fam
ily,
mig
rati
on l
eadi
ng
to i
ncre
ase
in s
tres
s an
d hi
gh r
isk
heal
th
beha
viou
r.
• In
crea
sing
glo
baliz
atio
n an
d gl
obal
mob
ility
mea
ns d
isea
ses
know
no
boun
dari
es.
• • Yo
unge
r po
pula
tion
tha
t is
mor
e w
illin
g to
acc
ept
new
er t
ech -
nolo
gies
• • Br
eakd
own
of s
ocia
l su
ppor
t st
ruct
ures
, tr
adit
iona
l fa
mily
, m
igra
tion
lea
ding
to
incr
ease
in
str
ess
and
high
ris
k he
alth
be
havi
our.
• De
mog
raph
ic d
ivid
end
from
a r
elat
ivel
y yo
unge
r po
pula
tion
pr
ovid
ing
mor
e co
n -tr
ibut
ors
wit
h fe
wer
di
seas
es
• Ri
sk f
or g
loba
l ep
idem
ics
is
high
(SA
RS,
Scar
let
feve
r, ch
ol-
era)
. Ep
idem
ic r
isk
has
maj
or
finan
cial
ris
k to
NH
IF.• •
Mis
mat
ch b
etw
een
the
need
s of
a y
oung
pop
ulat
ion
and
NH
IF p
rodu
cts
and
valu
e ch
ain.
Yo
ung
peop
le a
re l
ooki
ng f
or
conv
enie
nt c
onfid
enti
al s
ervi
ces
for
exam
ple
sign
ifica
nt s
ervi
ces
for
heal
th p
rom
otio
n an
d di
s -ea
se p
reve
ntio
n
Tech
nolo
gica
l•
Expo
nent
ial
grow
th
of t
echn
olog
ies
that
ca
n tr
ansf
orm
how
he
alth
care
is
deliv
-er
ed a
nd fi
nanc
ed
for
exam
ple
mob
ile
phon
e te
chno
logy
, m
inia
turi
zati
on o
f di
agno
stic
s, i
nter
net
of t
hing
s, w
eara
ble
mon
itor
ing
devi
ces,
te
lem
edic
ine,
tel
e ra
diol
ogy,
rem
ote
diag
nost
ics
etc.
• Ex
pone
ntia
l gr
owth
of
tec
hnol
ogie
s th
at
can
tran
sfor
m h
ow
heal
thca
re i
s de
liv-
ered
and
fina
nced
fo
r ex
ampl
e m
obile
ph
one
tech
nolo
gy,
min
iatu
riza
tion
of
diag
nost
ics,
int
erne
t of
thi
ngs,
wea
rabl
e m
onit
orin
g de
vice
s,
tele
med
icin
e, t
ele
radi
olog
y, r
emot
e di
agno
stic
s et
c.
• Ex
pone
ntia
l gr
owth
of
tech
nol-
ogie
s th
at c
an t
rans
form
how
he
alth
care
is
deliv
ered
and
fin
ance
d fo
r ex
ampl
e m
obile
ph
one
tech
nolo
gy,
min
iatu
riza
-ti
on o
f di
agno
stic
s, i
nter
net
of t
hing
s, w
eara
ble
mon
itor
ing
devi
ces,
tel
emed
icin
e, t
ele
ra-
diol
ogy,
rem
ote
diag
nost
ics
etc.
• •
Chan
ge i
n di
seas
e pa
tter
ns d
ue
to e
nvir
onm
ent
chan
ges
for
exam
ple
glob
al w
arm
ing
lead
ing
to r
e-em
erge
nce
of o
ld d
isea
ses
and
path
ogen
s en
teri
ng n
ew
regi
ons.
• • In
crea
sing
env
iron
men
tal
pollu
-ti
on l
eadi
ng t
o an
inc
reas
e of
ch
roni
c di
seas
es (
lung
, ca
r-di
ovas
cula
r, m
enta
l, n
euro
nal
dise
ases
) w
ill l
ead
to i
ncre
ased
he
alth
care
cos
ts.
• Te
chno
logy
has
the
po
tent
ial
to r
educ
e he
alth
care
cos
ts.
• • En
viro
nmen
tal
Impa
ct
asse
ssm
ent
beco
min
g le
gal
requ
irem
ent
• In
trod
ucti
on o
f ne
w d
iagn
osti
cs
and
ther
apeu
tic
tech
nolo
gies
w
ill h
ave
an i
mpa
ct o
n co
st
of c
are.
• •
Incr
easi
ng h
ealt
hcar
e co
sts
from
dis
ease
s an
d tr
aum
a ar
isin
g fr
om e
nvir
onm
enta
l de
grad
atio
n• •
Adve
rse
clim
atic
cha
nges
• • In
crea
sed
pollu
tion
and
ent
ry
of p
ollu
tant
s
14
25
Issu
es/d
evel
opm
ents
tha
t ar
e lik
ely
to i
mpa
ct o
n N
HIF
cap
acit
y to
ach
ieve
its
obj
ecti
ves.
Eff
ects
of
the
chan
ges
pres
ent
in t
erm
s of
opp
ortu
niti
es
and
thre
ats
to N
HIF
Dim
ensi
onG
loba
llyRe
gion
ally
Nat
iona
llyO
ppor
tuni
ties
Thre
ats
(Cha
lleng
es)
Ecol
ogic
al F
orce
s•
Chan
ge i
n di
seas
e pa
tter
ns d
ue t
o en
-vi
ronm
ent
chan
ges
for
exam
ple
glob
al
war
min
g le
adin
g to
re
-em
erge
nce
of o
ld
dise
ases
and
pat
ho-
gens
ent
erin
g ne
w
regi
ons.
• In
crea
sing
env
iron
men
-ta
l po
lluti
on l
eadi
ng
to a
n in
crea
se o
f ch
roni
c di
seas
es (
lung
, ca
rdio
vasc
ular
, m
en-
tal,
neu
rona
l di
seas
es)
will
lea
d to
inc
reas
ed
heal
thca
re c
osts
.
• Cl
imat
e ch
ange
will
im
pact
oth
er s
ocia
l de
term
inan
ts o
f he
alth
su
ch a
s ho
useh
old
inco
me,
foo
d su
pply
, se
curi
ty,
wat
er a
vail-
abili
ty
• Co
nflic
t an
d so
cial
di
srup
tion
s ov
er s
carc
e na
tura
l re
sour
ces.
• Ch
ange
in
dise
ase
patt
erns
due
to
envi
ronm
ent
chan
ges
for
exam
ple
glob
al
war
min
g le
adin
g to
re
-em
erge
nce
of o
ld
dise
ases
and
pat
ho-
gens
ent
erin
g ne
w
regi
ons.
• In
crea
sing
env
iron
-m
enta
l po
lluti
on
lead
ing
to a
n in
-cr
ease
of
chro
nic
dise
ases
(lu
ng,
car-
diov
ascu
lar,
men
tal,
ne
uron
al d
isea
ses)
w
ill l
ead
to i
ncre
ased
he
alth
care
cos
ts.
• Cl
imat
e ch
ange
will
im
pact
oth
er s
o-ci
al d
eter
min
ants
of
hea
lth
such
as
hous
ehol
d in
com
e,
food
sup
ply,
sec
urit
y,
wat
er a
vaila
bilit
y
• Co
nflic
t an
d so
cial
di
srup
tion
s ov
er
scar
ce n
atur
al r
e-so
urce
s.
• Cl
imat
e ch
ange
will
im
-pa
ct o
ther
soc
ial
dete
r-m
inan
ts o
f he
alth
suc
h as
ho
useh
old
inco
me,
foo
d su
pply
, se
curi
ty,
wat
er
avai
labi
lity
• Co
nflic
t an
d so
cial
dis
-ru
ptio
ns o
ver
scar
ce
natu
ral
reso
urce
s.
• In
adeq
uate
dis
ease
pre
-ve
ntio
n pr
ogra
m s
uch
as i
n th
e ar
ea o
f he
alth
nu
trit
ion.
• Pr
even
tion
pro
gram
s
• De
velo
pmen
t of
dis
ease
pr
even
tion
pro
gram
s su
ch a
s in
the
are
a of
he
alth
nut
riti
on
• O
vera
ll in
crea
sed
heal
th c
osts
• In
crea
sed
lifes
tyle
di
seas
es
15
2626
2.3 The SWOT Analysis
This section outlines a number of Strengths, Weaknesses, Opportunities and Threats (SWOT) which are summarized in Table 2.3;
Table 2.3 The SWOT Analysis
2.4 Stakeholder Analysis
In order for the Fund to fulfill its mandate, it is critical that it continually engag-es with a wide range of stakeholders. A list of stakeholders and their expectations from the Fund are depicted in Table 2.5
STRENGHTHS OPPORTUNITIES
• Competent and motivated staff• Presence in all the 47 Counties• Secure revenue from formal sector• Political goodwill from National and County Governments• Diversified product portfolio• Existence of robust ICT Infrastructure• Strong brand and international recognition
• Large uninsured population• Partnership with National, County • Governments and Development Partners • Advancement in technology• Growing economy and increasing awareness of health insurance services
WEAKNESS THREATS
• Inadequate legal framework • nadequate organizational capacity • Inadequate stakeholder engagement • Insufficient coverage of certain demographic groups• Resistance to change • Inadequate provider accreditation an payment systems
• Escalating healthcare costs• Voluntary nature of the informal sector; • Adverse selection leading to financial loss• Competition from other healthcare financin mechanisms • Unethical practices• Unwarranted negative perception and publicity• Rapid technological obsolescence
16
27
No Stakeholders What they expect of NHIF? What NHIF expect of stakeholders
1 Members/ Contributors • Quality services (Timely, value for mon-ey, Prompt communication, provision of alternative service points) Fiduciary responsibility
• Registration as members• Prompt declaration of dependents• Actual and accurate informationHonesty• Timely payment of contributions
2 Health Care Providers • Financially sound Immediate settlement of their bills for services rendered
• Quality service and honesty
3 National and County Government
• Prudent management of resources• Provision of Universal Health Care (UHC)
• Enabling environment:• Legislation • Policy• Health infrastructure• Financing (Sponsorship)
4 Board • Effective delivery of mandate of the Fund • Provide Strategic direction• Determine operation policy• Resource mobilization• Play an oversight role in the management of
the Fund • Project a positive image of the Fund
5 Employers organizations • Quality services (Timely, value for mon-ey, Prompt communication, provision of alternative service points)
• Actual deductions (correct figure and number of contributors) and timely remittance
• Actual and accurate information on bi-product
6 Sponsors • Quality services (Timely, value for mon-ey, Prompt communication, provision of alternative service points)
• Prudent management of resources• Timely reporting
• Timely disbursements• Actual and accurate information of benefi-
ciaries
7 SponsorsService providers/suppliers
• Transparency• Accountability• Timely payments• Prompt communication
• Quality goods and services• Honesty• Compliance with National and International
standards• Compliance with the legal requirements• Prompt communication
8 NHIF Staff • Conducive work environment• Fair and competitive remuneration • Career growth and development
• Productivity• Professionalism• Honesty• Accountability• Innovation and creativity• Confidentiality
9 Members of the 4th Estate
• Information • Mutual engagement• Positive coverage
10 Regulatory Councils • Strict Adherence to standards/ guidelines • Licensing of HCPs and Health Personnel
Table 2.4: Stakeholder Analysis
The stakeholders identified above are critical to the success of the Fund. Stakeholder analysis will be a continuous exercise as needs and wants are dynamic and institutional/stakeholder affiliations change over time. This will ensure cooperation and support in the achievement of the Fund’s mission and realization of its vision.
17
29
CHAPTER 3: STRATEGIC FRAMEWORK
3.1 Introduction The strategic framework comprises the mandate, core functions, vision, mission, values, themes, issues, objectives and corresponding strategies.
3.2 Mandate The mandate of NHIF is to facilitate access to quality healthcare through strategic resource pooling and healthcare purchasing in collaboration with stakeholders
3.3 Core FunctionsThe core functions of NHIF are to:- i. Receive all contributions and other payments required by this Act to be made to the Fund; ii. Make payments out of the Fund to declared hospitals in accordance with the provisions of this Act; iii. In consultation with the Minister, to set the criteria for the declaration of hospitals and to declare such hospitals in accordance thereto for the purposes of this Act; iv. Regulate the contributions payable to the Fund and the benefits and other payments to be made out the Fund; v. Protect the interests of contributors to the Fund; vi. Advise the Minister on the national policy to be followed with regard to na-tional health insurance and to implement all Government policies relating thereto; and vii. Perform such other functions as are conferred on it by this Act or by any other written law.
3.4 Vision Statement World Class Universal Social Health Insurer
3.5 Mission Statement To contribute towards universal health coverage in the provision of affordable, ac-cessible, sustainable and quality health insurance through strategic resource pool-ing and healthcare purchasing in collaboration with stakeholders
3.6 Core Value Statements Value statements constitute a set of beliefs and standards of behaviour that drive the NHIF agenda. The following are our values and are essential and must be up-held as they are key to corporate culture and identity:
•Customer Responsiveness: We commit ourselves to attaining the highest stan-dards in service delivery to all stakeholders’ expectations.
19
3030
•Ethics and Professionalism: We are committed to acting in an honest, account-able, transparent and competent manner.
•Team Spirit: We embrace a participatory approach in all our activities.
•Partnerships and Collaborations: We are committed to working with other stake-holders for effective service delivery.
•Innovation and Creativity: We will embrace change and continuous improvement in our service delivery.
•Corporate Social Sustainability: We shall ensure good corporate citizenship and value to communities by ensuring compliance with our legal and statutory obliga-tions. We will be sensitive to issues that affect the environment.
3.7 Value PropositionIn the wake of the global and national drive to reform and reorganize health sys-tems, the Fund has enhanced its approach towards health financing to enable the attainment of Universal Health Coverage. This enhancement has led to the inevita-ble change in the Funds value proposition.
Conventionally, conversations on health system value have focused on quality over cost assessment as entrenched from the perspective of the organisation. However, this Strategic Plan, while still observing conventional paradigms, has given signif-icant consideration to customer & stakeholder satisfaction. This has been charac-terized by the development of deliberate strategies aimed at improving accessibil-ity to services, enhancing the product mix and educating stakeholders. All these efforts are expected to steer the country towards the attainment of UHC by 2022 through increasing the Funds number of principal members from 7 million to 19 million in the implementation period.
Building on achievements of strategic plans, this Strategic Plan describes strategies aimed at enhancing all sectors. In this regard, the Fund has remodelled its value chain. The value chain defines support activities which have a focus on strength-ening of internal controls which are expected to be instrumental in realization of primary activities. These activities are expected to pave the way for customer and stakeholder value creation.
20
31
Figure 3.1 : Value Proposition.
21
3232
3.8
S
trat
egic
Iss
ues,
Goa
ls,
Obj
ecti
ves,
and
Str
ateg
ies
3.8.
1 S
trat
egy
Map
22
The following strategic issues, goals, objectives and strategies have been identified as priority areas (key result areas) for implementation during the plan period.
STRATEGIC ISSUE 1: INCREASE QUALITY HEALTH INSURANCE COVERAGE Objective 1: To Increase number of principal members from 7 million to 19 million by 2022 Strategies1.1 Enhance compliance with statutory contributions 1.2 Adopt innovative and efficient access points for NHIF services 1.3 Enhance strategic marketing and public education for recruitment of the informal sector 1.4 Attain and sustain 70% member retention rate1.5 Enhance the existing benefit packages and develop new product mix 1.6 Improve accessibility of benefit packages 1.7 Enhance marketing research and product development 1.8 Educate customers on new and existing products/benefit packages
STRATEGIC ISSUE 2: ENHANCE FINANCIAL BASEObjective : To Enhance Revenue Inflows and It’s UtilizationStrategies2.1 Diversify and enhance sources of funding in line with social health insurance princi-ples2.2 Adopt strategic business development to increase managed schemes and aggregated groups in the informal sector2.3 Enhance healthcare financing on indigents by the County Governments 2.4 Reduce administration expense to total contribution ratio from 17 to no more than 15 percent 2.5 Enhance strategic purchasing of benefits from healthcare providers 2.6 Strengthen internal controls2.7 Collaborate with complementary insurance schemes to enhance service delivery 2.8 Ensure prudent investment of financial resources
STRATEGIC ISSUE 3: ENHANCE INSTITUTIONAL CAPACITY Objective 3: Enhance good corporate governance strategies Strategies 3.1 Enhance Legal and regulatory framework 3.2 Institutionalize an effective management system 3.3 Inculcate a performance oriented corporate culture 3.4 Implement the new organization structure 3.5 Mainstream application of technology in service delivery
STRATEGIC ISSUE 4: STAKEHOLDER ALLIANCES AND PARTNERSHIPS Objective 4: To Enhance synergies in information and resource sharing with partners and stakeholders. Strategies4.1 Enhance engagement and buy-in with stakeholders4.2 Collaborate with complementary Agencies/Insurance schemes to expand channels for NHIF products 4.3 Mainstream Corporate Social Sustainability (CSS) Initiatives
23
Implementation of the objectives and strategies outlined above will enable NHIF to address a number of challenges as set out in this Plan.
ISSU
EST
RATE
GIC
OBJ
EC-
TIVE
.ST
RATE
GY
ACT
IVIT
Y/IN
ITIA
TIVE
.KE
Y PE
RFO
RMA
NCE
IN
DIC
ATO
R.
ENH
ANCE
FIN
ANCI
AL
BASE
Enha
nce
reve
nue
inflo
w a
nd i
ts
utili
zati
on
• Di
vers
ify
and
enha
nce
sour
ces
of f
undi
ng i
n lin
e w
ith
soci
al h
ealt
h in
sur-
ance
pri
ncip
les
Incr
ease
con
trib
utio
ns f
rom
44
Billi
on t
o 83
Bi
llion
thr
ough
inc
reas
e in
mem
bers
hip
in:
• Fo
rmal
Sec
tor.
• In
form
al S
ecto
r.•
Subs
idie
s.
• Re
venu
e gr
owth
• Ex
pand
ed c
over
age
• Ad
opt
stra
tegi
c bu
sine
ss
deve
lopm
ent
to i
ncre
ase
man
aged
sch
emes
and
ag
greg
ated
gr
oups
in
the
info
rmal
sec
tor
• Cr
eate
aw
aren
ess
on n
ew s
chem
es a
nd
solic
it f
or i
nsur
ance
bus
ines
s fr
om o
rga-
niza
tion
s/en
titi
es.
• Co
nduc
t m
arke
t st
udy
and
epid
emio
logi
c da
ta r
evie
ws
of t
arge
ted
grou
ps.
• Co
nduc
t ac
tuar
ial
revi
ews
and
desi
gn/
revi
ew p
rodu
cts.
• Aw
aren
ess
leve
ls•
Mar
ket
stud
y re
port
.•
Appr
oved
pro
duct
s.
• Re
port
on
new
sch
emes
• En
hanc
e he
alth
care
fin
anci
ng o
n in
dige
nts
by
the
Nat
iona
l an
d Co
unty
G
over
nmen
ts
• Cr
eate
aw
aren
ess
and
educ
ate
coun
ty
gove
rnm
ent
on t
he n
eed
to c
ontr
ibut
e to
cov
er t
he p
oor
and
info
rmal
sec
tor
popu
lati
ons
thro
ugh
NH
IF.•
Deve
lop
and
impl
emen
t pa
rtne
rshi
p w
ith
coun
ty g
over
nmen
ts t
o ex
pand
cov
erag
e fo
r th
e in
form
al s
ecto
r an
d in
dige
nts.
• Id
enti
fy g
roup
s fo
r fu
ll/pa
rtia
l su
bsid
y an
d en
gage
Gov
ernm
ent,
CDF
and
par
t-ne
rs
• Aw
aren
ess
leve
l.•
Part
ners
hip
agre
emen
t.•
Amou
nt o
f su
bsid
y ra
ised
.
• En
hanc
e eff
ecti
ve a
nd
effici
ent
utili
zati
on o
f re
sour
ces
• Re
duce
adm
inis
trat
ion
expe
nse
to t
otal
co
ntri
buti
on r
atio
fro
m 1
7% t
o no
t m
ore
than
15%
.•
Enha
nce
stra
tegi
c pu
rcha
sing
of
bene
fits
from
hea
lthc
are
prov
ider
s.•
Stre
ngth
en b
enefi
t ut
iliza
tion
/Cas
e m
anag
emen
t
• Ad
min
istr
atio
n co
st r
atio
•
Pay
out
rati
o be
twee
n 65
-75%
• Re
duce
adm
inis
trat
ion
expe
nse
to t
otal
con
tri-
buti
on r
atio
fro
m 1
7% t
o no
mor
e th
an 1
5%.
• Id
enti
fy k
ey a
dmin
istr
ativ
e co
st d
rive
rs•
Impl
emen
t co
st r
educ
tion
mea
sure
s ba
sed
on t
he i
dent
ified
are
as.
• Ad
min
istr
atio
n co
st r
atio
CHA
PTER
4:
THE
BALA
NCE
SCO
RECA
RD 2
018-
202
2
4.1
Fi
nanc
ial
Pers
pect
ive
25
ISSU
EST
RATE
GIC
OBJ
ECTI
VE.
STRA
TEG
YA
CTIV
ITY/
INIT
IATI
VE.
KEY
PERF
ORM
AN
CE I
ND
ICAT
OR.
ENH
ANCE
FIN
ANCI
AL
BASE
Ensu
re e
ffec
tive
and
effi
cien
t ut
iliza
tion
of
res
ourc
es.
Enha
nce
stra
tegi
c pu
rcha
sing
of
ben
efits
fro
m h
ealt
hcar
e pr
ovid
ers.
• Co
nduc
t co
stin
g of
ser
vice
s ac
ross
va
riou
s le
vels
of
care
to
info
rm
bene
fit d
esig
n an
d pa
ymen
t m
echa
nism
.•
Depl
oy i
nnov
ativ
e an
d effi
cien
t PP
Ms
appr
opri
ate
to d
iffer
ent
bene
fit
pack
ages
and
lev
els
of c
are
• St
reng
then
ben
efit
utili
zati
on/C
ase
man
agem
ent
• Co
stin
g re
port
• Av
erag
e co
st p
er c
laim
cat
egor
y •
Pay
out
rati
on b
etw
een
65-7
5%
Colla
bora
te w
ith
com
plem
en-
tary
ins
uran
ce s
chem
es t
o en
hanc
e se
rvic
e de
liver
y
• De
velo
p an
d ag
ree
on c
o-in
sura
nce
mod
els
wit
h pr
ivat
e/co
mm
unit
y in
sur-
ance
s in
cla
ims
sett
lem
ent.
• Pa
rtne
rshi
p ag
reem
ent.
Stre
ngth
en i
nter
nal
cont
rols
• Re
view
and
im
plem
ent
finan
ce p
oli-
cies
, re
gula
tion
s an
d m
anua
ls (
Inte
r-na
l &
Ext
erna
l)•
Revi
ew,
upda
te a
nd i
mpl
emen
t th
e Ri
sk a
nd A
udit
pol
icy
regu
lati
ons
and
man
uals
• H
arm
oniz
e Fi
nanc
e/Au
dit/
Risk
wit
h In
form
atio
n se
curi
ty p
olic
ies
and
syst
ems
• Re
vise
d po
licie
s an
d m
anua
ls•
Sync
hron
ized
fina
nce,
ris
k, a
udit
&
ICT
secu
rity
sys
tem
Ensu
re p
rude
nt i
nves
tmen
t of
fina
ncia
l re
sour
ces
• Re
vise
and
im
plem
ent
inve
stm
ent
stra
tegy
• Re
view
and
opt
imiz
e cu
rren
t in
vest
-m
ent
clas
ses/
asse
ts
• De
velo
p ne
w i
nves
tmen
t op
port
unit
ies
• Re
vise
d In
vest
men
t st
rate
gy•
Num
ber
of n
ew i
nves
tmen
t op
port
unit
ies
STAK
EHO
LDER
AL-
LIAN
CES
AND
PART
-N
ERSH
IPS
Enha
nce
syne
rgie
s in
in
form
atio
n an
d re
-so
urce
sha
ring
wit
h st
akeh
olde
rs.
Enha
nce
enga
gem
ent
and
buy-
in w
ith
stak
ehol
ders
• Ad
voca
te f
or m
atch
ed c
ontr
ibut
ion
from
em
ploy
ers.
• Ad
voca
cy f
or i
mpl
emen
tati
on o
f a
perc
enta
ge d
educ
tion
of
empl
oyee
in
com
e.
• En
gage
men
t pl
an.
• En
gage
men
t re
port
. •
Draf
t of
pro
pose
d am
endm
ents
.
26
ISSU
EST
RATE
GIC
OBJ
ECTI
VE.
STRA
TEG
YA
CTIV
ITY/
INIT
IATI
VE.
KEY
PERF
ORM
AN
CE I
ND
ICAT
OR.
INCR
EASE
QU
ALIT
Y H
EALT
H I
NSU
RAN
CE
COVE
RAG
E
Incr
ease
num
ber
of
prin
cipa
l m
embe
rs
from
7 m
illio
n to
19
mill
ion
by 2
022
Enha
nce
com
plia
nce
wit
h m
anda
tory
con
trib
utio
ns•
Re-e
ngin
eer
the
com
plia
nce
proc
ess
• Pa
rtne
r w
ith
Nat
iona
l &
Cou
nty
gove
rnm
ents
and
pri
vate
sec
tor
to
enha
nce
com
plia
nce.
•
Inte
grat
e w
ith
othe
r go
vern
men
t ag
enci
es f
or d
ata
min
ing
• Re
-eng
inee
red
proc
ess.
• Pa
rtne
rshi
p ag
reem
ent.
• N
o. o
f ag
enci
es i
nteg
rate
d
Adop
t in
nova
tive
and
effi
cien
t ac
cess
poi
nts
for
NH
IF s
ervi
ces
• Re
view
the
exi
stin
g ac
cess
poi
nts.
•
Impl
emen
t Re
com
men
dati
ons.
• De
velo
p in
nova
tive
and
cos
t eff
ecti
ve
acce
ss p
oint
s.•
Crea
te a
war
enes
s on
the
acc
ess
poin
ts.
• In
crea
se s
trat
egic
par
tner
ship
s fo
r se
rvic
e de
liver
y/Ag
ency
Mod
el.
• N
o. o
f re
view
ed a
cces
s po
ints
.•
Awar
enes
s le
vel
Enha
nce
stra
tegi
c m
arke
ting
an
d pu
blic
edu
cati
on•
Esta
blis
h Br
and
equi
ty i
ndex
• De
velo
p an
int
egra
ted
mar
keti
ng c
om-
mun
icat
ion
(IM
C) a
nd p
ublic
edu
cati
on
plan
.•
Enga
ge s
trat
egic
par
tner
ship
s fo
r m
arke
ting
com
mun
icat
ion
and
publ
ic
educ
atio
n.
• Br
and
equi
ty r
epor
t.•
Part
ners
hip
agre
emen
ts.
Atta
in a
nd s
usta
in 7
0% m
em-
ber
rete
ntio
n ra
te•
Esta
blis
h dr
iver
s of
cus
tom
er
sati
sfac
tion
.•
Revi
ew e
xist
ing
cust
omer
loy
alty
pr
ogra
mm
e.•
Impl
emen
t a
cust
omer
loy
alty
pr
ogra
mm
e.•
Acqu
ire
1000
2:20
14 Q
ualit
y M
anag
emen
t on
Cus
tom
er s
atis
fact
ion.
• Cu
stom
er s
atis
fact
ion
inde
x
4.2
Cu
stom
er P
ersp
ecti
ve
27
ISSU
EST
RATE
GIC
OBJ
ECTI
VE.
STRA
TEG
YA
CTIV
ITY/
INIT
IATI
VE.
KEY
PERF
ORM
AN
CE
IND
ICAT
OR.
Enha
nce
the
exis
ting
ben
efit
pack
ages
and
dev
elop
a n
ew
prod
uct
mix
• De
velo
p an
d im
plem
ent
a st
anda
rd b
enefi
t pa
ckag
e•
Revi
ew f
acili
ty a
sses
smen
t to
ol t
o al
ign
it t
o pr
imar
y he
alth
care
pro
vide
rs•
Decl
are
and
cont
ract
pri
mar
y he
alth
care
fac
iliti
es.
• Re
view
hea
lth
prov
ider
s ne
twor
k in
lin
e w
ith
bene
fit
pack
ages
and
im
plem
ent
reco
mm
enda
tion
s.•
Prom
ote
inve
stm
ents
in
heal
thca
re s
ervi
ces
in u
nder
-se
rved
are
as.
• Pa
rtne
r an
d re
cogn
ize
skill
ed c
omm
unit
y m
idw
ives
.•
Prom
ote
use
of m
obile
clin
ics
• La
unch
and
im
plan
tati
on o
f m
ulti
-tie
red
bene
fits.
• De
velo
p a
tele
med
icin
e po
licy
and
part
ner
wit
h te
le-
med
icin
e/m
-hea
lth
orga
nisa
tion
s to
exp
and
acce
ss.
• De
velo
p a
polic
y on
eng
agem
ent
wit
h ph
arm
aceu
tica
l co
mpa
nies
• St
anda
rd b
enefi
t pa
ckag
e•
Revi
ewed
fac
ility
ass
ess-
men
t to
ol•
No
of d
ecla
red
faci
l-it
ies.
•
New
fac
iliti
es i
n ta
rget
ar
eas
• N
o. o
f pa
rtne
rs.
STAK
EHO
LDER
AL
LIAN
CES
AND
PART
NER
SHIP
S
Enha
nce
syne
rgie
s in
in
form
atio
n an
d re
sour
ce
shar
ing
wit
h st
akeh
olde
rs a
nd
part
ners
.
Colla
bora
te w
ith
com
plem
enta
ry
Agen
cies
/Ins
uran
ce s
chem
es
to e
xpan
d ch
anne
ls f
or
NH
IF
prod
ucts
• De
velo
p an
d ag
ree
on c
o-in
sura
nce
mod
els
wit
h pr
ivat
e/co
mm
unit
y in
sura
nces
in
clai
ms
sett
lem
ent.
• M
ap a
ll pr
ivat
e an
d co
mm
unit
y-ba
sed
heal
th
insu
ranc
e sc
hem
es.
• De
velo
p an
d im
plem
ent
part
ners
hip
mod
els
in
dist
ribu
tion
of
NH
IF p
rodu
cts
(Age
ncie
s).
• Pa
rtne
rshi
p ag
reem
ent.
• M
appi
ng r
epor
t.
Mai
nstr
eam
the
Cor
pora
te S
ocia
l Su
stai
nabi
lity
(CSS
) In
itia
tive
s
• Re
view
the
cor
pora
te s
usta
inab
ility
pol
icy
in l
ine
wit
h em
ergi
ng i
ssue
s an
d de
velo
p a
stra
tegy
. •
Deve
lop
a co
rpor
ate
sust
aina
bilit
y pr
ogra
mm
e.•
Deve
lop
and
impl
emen
t a
corp
orat
e su
stai
nabi
lity
fram
ewor
k an
d pa
rtne
rshi
p m
odel
s fo
r eff
ecti
ve
linka
ges
• Id
enti
fy a
nd i
mpl
emen
t ch
anne
ls o
f co
mm
unic
atin
g co
rpor
ate
sust
aina
bilit
y in
itia
tive
s
• A
CSR
prog
ram
.
INCR
EASE
QU
ALIT
Y H
EALT
H I
NSU
RAN
CE
COVE
RAG
E
To d
evel
op a
pro
duct
mix
tha
t ex
ceed
s cu
stom
er e
xpec
tati
ons
Enha
ncin
g m
arke
ting
res
earc
h an
d pr
oduc
t de
velo
pmen
t.
• Co
nduc
t ap
prop
riat
e m
arke
t re
sear
ch (
in-h
ouse
, co
llabo
rati
ve a
nd o
utso
urci
ng•
Impl
emen
t re
com
men
dati
ons
of m
arke
t re
sear
ch.
• Re
sear
ch r
epor
t.•
Impl
emen
tati
on s
tatu
s re
port
.
Educ
ate
cust
omer
s on
exi
stin
g pr
oduc
ts/b
enefi
t pa
ckag
es.
• Re
view
and
sta
ndar
dize
Inf
orm
atio
n, E
duca
tion
&
Com
mun
icat
ion
(IEC
) M
ater
ials
• De
velo
p an
d im
plem
ent
an e
duca
tion
and
co
mm
unic
atio
n pl
an•
Impr
ove
know
ledg
e ba
se o
f cu
stom
ers
on p
rodu
cts
and
righ
ts
• IE
C re
port
.•
Educ
atio
n pl
an.
• Cu
stom
er k
now
ledg
e on
pro
duct
s an
d ri
ghts
in
dex
28
ISSU
EST
RATE
GIC
OBJ
ECTI
VE.
STRA
TEG
YA
CTIV
ITY/
INIT
IATI
VE.
KEY
PERF
ORM
AN
CE
IND
ICAT
OR.
ENH
ANCE
IN
STIT
UTI
ON
AL
CAPA
CITY
Enha
nce
com
plia
nce
to
good
cor
pora
te g
over
nanc
e M
ains
trea
m a
pplic
atio
n of
te
chno
logy
in
serv
ice
deliv
ery
• In
crea
se a
utom
atio
n of
bus
ines
s pr
oces
ses
• En
hanc
e cu
stom
er e
xper
ienc
e us
ing
tech
nolo
gy•
Enha
nce
info
rmat
ion
syst
em s
ecur
ity
and
cont
rols
• %
of a
utom
atio
n•
Impl
emen
tati
on
repo
rt.
• U
pdat
ed B
iom
etri
c sy
stem
. •
Upd
ated
web
site
.•
A CR
M s
yste
m.
• U
pdat
ed a
nd
depl
oyed
inf
orm
atio
n se
curi
ty p
olic
y.
STAK
E H
OLD
ER
ALLI
ANCE
S AN
D PA
RTN
ERSH
IPS
Enha
nce
syne
rgie
s in
in
form
atio
n an
d re
sour
ce
shar
ing
wit
h st
akeh
olde
rs
and
part
ners
.
Enha
nce
enga
gem
ent
and
buy-
in w
ith
stak
ehol
der
• Ca
rry
out
stak
ehol
der
map
ping
• Id
enti
fy a
nd i
mpl
emen
t su
itab
le
com
mun
icat
ion
chan
nels
• Co
ntin
uous
eng
agem
ent
wit
h ke
y st
akeh
olde
rs
to s
tren
gthe
n pa
rtne
rshi
p an
d su
stai
nabi
lity.
• Se
cure
sta
keho
lder
sup
port
in
lega
l an
d re
gula
tory
pro
cess
.
• M
appi
ng r
epor
t.•
Stak
ehol
der’
s sa
tis-
fact
ion
inde
x.•
Num
ber
of a
dvoc
acy
enga
gem
ents
.
INCR
EASE
Q
UAL
ITY
HEA
LTH
IN
SURA
NCE
CO
VERA
GE
Incr
ease
num
ber
of
prin
cipa
l m
embe
rs f
rom
7
mill
ion
to 1
9 m
illio
n by
20
22
Impr
ove
acce
ssib
ility
of
bene
fit p
acka
ges
• De
velo
p an
d im
plem
ent
a st
anda
rd b
enefi
t pa
ckag
e•
Revi
ew f
acili
ty a
sses
smen
t to
ol t
o al
ign
it t
o pr
imar
y he
alth
care
pro
vide
rs•
Decl
are
and
cont
ract
pri
mar
y he
alth
care
fa
cilit
ies.
• St
anda
rd b
enefi
t pa
ckag
e•
Revi
ewed
too
l•
No
of d
ecla
red
faci
litie
s.
4.3
In
tern
al/P
roce
ss P
ersp
ecti
ve
29
ISSU
EST
RATE
GIC
OBJ
EC-
TIVE
.ST
RATE
GY
ACT
IVIT
Y/IN
ITIA
TIVE
.KE
Y PE
RFO
RMA
NCE
IN
DIC
A-
TOR.
ENH
ANCE
IN
STIT
UTI
ON
AL
CAPA
CITY
Enha
nce
com
plia
nce
to
good
co
rpor
ate
gove
rnan
ceEn
hanc
e Le
gal
and
regu
lato
ry f
ram
ewor
k.
• Co
nduc
t le
gal
and
regu
lato
ry a
udit
in
NH
IF
Valu
e Ch
ain.
• Se
cure
sta
keho
lder
sup
port
in
lega
l an
d re
gula
tory
pro
cess
.
•
Im
plem
enta
tion
rep
ort.
•
N
o. o
f ad
voca
cy
enga
gem
ents
and
rep
ort.
Inst
itut
iona
lize
an e
ffec
tive
m
anag
emen
t sy
stem
• Im
plem
ent
the
new
BSC
sys
tem
and
tra
in
staff
.•
Mon
itor
uti
lizat
ion
at b
oth
corp
orat
e &
in
divi
dual
lev
el•
Deve
lop
a co
rpor
ate
cris
is m
anag
emen
t fr
amew
ork.
• Re
view
ris
k m
anag
emen
t po
licy
• Ev
alua
te t
he i
mpl
emen
tati
on o
f th
e ri
sk
man
agem
ent
fram
ewor
k.•
Ensu
re c
ompl
ianc
e w
ith
good
cor
pora
te
gove
rnan
ce p
ract
ices
.
• Tr
aini
ng p
rogr
am a
nd
utili
zati
on r
epor
ts•
Cris
is c
orpo
rate
m
anag
emen
t fr
amew
ork.
• Re
view
ed p
olic
y.
Incu
lcat
e a
perf
orm
ance
or
ient
ed c
orpo
rate
cul
ture
• Ca
paci
ty b
uild
ing
& c
hang
e m
anag
emen
t.•
Crea
te a
war
enes
s of
and
im
plem
ent
grie
vanc
e ha
ndlin
g pr
oced
ures
.•
Impr
ove
inte
rnal
Com
mun
icat
ion
and
cons
ulta
tion
thr
ough
inn
ovat
ive
chan
nel
• En
hanc
e cr
eati
vity
and
inn
ovat
ion
(inn
ovat
ion
labs
/sum
mit
s).
• En
hanc
e M
anag
eria
l le
ader
ship
dev
elop
men
t th
roug
h tr
aini
ng,
coac
hing
and
men
tors
hip.
• Aw
aren
ess
leve
l•
Impl
emen
tati
on a
nd
eval
uati
on r
epor
• N
o. o
f In
nova
tion
lab
s.•
Men
tors
hip
prog
ram
.
Impl
emen
t th
e ne
w
orga
niza
tion
str
uctu
re
• U
nder
take
map
ping
& p
lace
men
t of
sta
ff t
o th
e up
date
d st
ruct
ure.
• U
pdat
e th
e ca
reer
pro
gres
sion
gui
delin
es.
• In
duct
sta
ff o
n th
e ne
w r
oles
& f
unct
ions
.
• M
appi
ng a
nd p
lace
men
t re
port
.•
Upd
ated
& a
ppro
ved
care
er g
uide
line.
4.4
O
rgan
izat
iona
l Ca
paci
ty
30
CHAPTER 5: PLAN IMPLEMENTATION
5.1 IntroductionThis chapter operationalizes the strategic objectives by linking plan formulation to monitoring and evaluation. It also identifies the staffing needs and how each functional area fits into the plan.
5.2 Implementation/Action Plan The implementation plan has documented what needs to be done, when it needs to be done, by who, and the resources needed to do it. The plan is the basis upon which monitoring and evaluation framework of the strategic plan will be developed. The relevant action plan matrices for the strategy is presented in Annex 1.
5.3 Organizational Structure and Human CapacityThe organization structure has been reviewed to align it to the strategies as shown in figure 5 below.
Figure 5 shows the NHIF High Level organizational structure.
5.4 Coordination MechanismNHIF will establish coordinating mechanisms to bring appropriate agencies together to determine level of appropriate involvement, timelines and provision of resources required for specific programmes and projects.
32
The operationalization of this coordination framework will be critical in realization of the Fund’s Vision. NHIF will therefore maintain and enhance these stakeholder relationships.
5.5 AccountabilityOverall, the Board of Directors will be responsible for the general monitoring and evaluation of the Plan’s implementation and prioritization of the projects to be undertaken. The Chief Executive, Heads of Department will, on the other hand, be responsible for the day-to-day implementation and monitoring and evaluation of actual performance. The quantitative and qualitative targets set in the Plan will be implemented through Annual Performance Contracts and target setting in individual staff work plans. 5.6 Risk and Risk ManagementThe implementation of this Plan is potentially exposed to various risks, among them, strategic, operational, financial and technological risks. NHIF will forecast possible risks under these categories and determine mitigation measures as depicted in Table 5.1.
The internal coordination mechanism will be achieved through periodic meetings and reporting systems of various management and administrative organs of NHIF including the Board of Directors and its standing committees, the senior management and departmental committees, and other operational units in the organization structure. The implementation (action plan) matrices (Annex 1) which clearly show what will be done and who will be responsible, among other details, will also be a principal coordinative mechanism.
The external coordination mechanism will primarily rest with the Board of Directors who represent key stakeholders. NHIF is also a member of national, regional and international agencies and other professional bodies. Such memberships and alliances will provide the much needed coordination of the Fund’s strategic and operational activities as depicted in Figure 6.
Figure 6: Plan Coordination Framework
33
Table 5.1: Risks and Mitigation Measures
NB: Low= L, Medium= M, High= H
Risks Level of Risk Mitigation of the Risks
Political RiskLack of Political Support High (H)
• Continuous engagements with the National and County Governments for political goodwill
Strategic Risks• Weak monitoring and
evaluation framework Medium (M)
• The planning process should be as participatory as possible to provide ownership and make implementation easy
• Effective monitoring and evalua-tion of the implementation process will be critical and an institutional framework will be established
Operational Risks• Lack of adequate stake-
holder support• Inadequate facilitation.
Low (L)
• Regular stakeholder forums to strengthen coordination and ensure stakeholder support
• Pursue various facilitation channels.
Financial Risks• Inadequate funding Medium (M)
• Seek strategic partnerships and other sources of funding
• Explore Public Private Partnership• Ensure prudent utilization of resourc-
es
Organizational Risks• Duplication of roles and
unclear reporting chan-nels.
Medium (M)• Organizational structure to spell
out clear roles, responsibilities and reporting channels
Technological Risks• Inability to cope with
rapid technological changes.
Medium (M)
• Acquisition, deployment and maintenance of technological equipment and appliances; regular training of staff and frequent upgrading of equipment in accordance with ICT trends
• Vetting and regular adoption of emerging technology
34
45
CHAPTER 6: RESOURCE FLOWS
6.1 Resource Mobilization
Successful implementation of the Strategic Plan will depend not only on the qual-ity and commitment of staff but also on the availability and efficient utilization of other resources. 6.2 Budgetary Requirements
The projected funds required for implementing the pertinent strategies,pro-grammes and projects outlined in this Plan are summarized in Table 6.1.
The Plan will be achieved through various strategies and activities. The financial resources required for implementing the strategies and activities are outlined in the implementation matrix. The total amount required for the period 2018/19-2022/23 is 9.286 Billion.
The financial resources expected to be generated from internal and external sources over the same period, based on the projected cash inflows as outlined in Table 6.2 is Ksh 87 Billion. Table 6.1 gives the financial resource requirements for all the stra-tegic issues while Table 6.2 and 6.3 outline the projected cash inflows and outflows respectively over the Strategic Plan period.
42 35
4646
STRATEGIC ISSUE STRATEGIC OBJECTIVE FY FY FY FY FY TOTAL
2018/19(IN MILLION Kshs.)
2019/20(IN MILLION Kshs.)
2019/20(IN MILLION Kshs.)
2021/22(IN MIL-LION Kshs.)
2022/23(IN MILLION Kshs.)
(IN MILLION Kshs.)
Issue 1: Increase Health Insurance Coverage
Objective 1: To increase number of principal members from 7 million to 19 million by 2022
680 579.25 579.25 579.25 579.25 2,997
Objective 2: To enhance revenue inflow and its utilization
94.3 93.4 93.4 93.4 93.4 467.9
Issue 2: Financial Base
Objective 3: To enhance compliance to good corporate governance
1,106. 1,137 1,127 1,091 5 386 4,922
Objective 4: To enhance synergies in information and resource sharing with stakeholders and partners
180 180 180 180 180 900
Total 9.286
Table 6.1: Summary of Budgetary Requirements (Cost) for Each Objective
36
47
SOURCE
FY 2018/19(Kshs. MN)
FY 2019/20(Kshs. MN)
FY2020/21(Kshs. MN)
FY2021/22(Kshs. MN)
FY2022/23 (Kshs MN)
TOTAL (Kshs. MN)
National Scheme 44,560 50,126 53,299 58,023 62,639 268,648
Negotiated Schemes 21,225 15,850 17,435 19,178 21,095 83,154
Subsidies- Indigents 7,332 - - - - 7,332
Subsidies- Linda Mama 4,298 - - - - 4,298
Investments 2,226 2,229 2,418 2,629 2,861 12,363
TOTAL 68,011 68,205 73,152 79,831 86,597 375,797
Table 6.2: Summary of Revenues by Source
Table 6.3: Financial Summary
TOTAL AMOUNTS (Kshs. Mil-lions)
Item Description Year 18/19 Year 19/20 Year 20/21 Year 21/22 Year 22/23 Total
Total Revenues 68,011 68,205 73,152 79,831 86,597 375,797
Total Recurrent Expenditures 60,262 63,741 69,822 76,266 83,496 353,587
Gap/Surplus (Total Revenues less Total Expenditures 7,748 4,463 3,331 3,565 3,100 22,207
Capital expenditures 1,970 2,589 2,822 3,048 3,200 11,659
44 37
4848
CHAPTER 7: MONITORING, EVALUATION AND REPORTING
7.1 Preamble Monitoring implementation of the strategic plan constitutes systematic tracking of activities and actions to assess progress. Progress will be measured against specific targets and schedules included in the Plan. The monitoring will identify difficulties and problem areas, with necessary immediate remedial action, thereby ensuring that the relevant targets are achieved. Regular reporting at all levels is necessary for follow-up and record keeping.
7.2 Strategies for Monitoring and Evaluation (M & E)7.2.1 Plan Implementation TeamThe Strategy & Planning Division Team will follow up and ensure that strategies are being imple-mented, performance measured, progress reports are made and discussed, and corrective action is taken when necessary.
7.2.2 Cascading the Plan to all cadres of StaffThe Plan and its targets will be cascaded downwards to the lowest positions. This will help each member of staff to understand and plan for their respective roles.
7.2.3 Departmental and Individual Annual Work PlansDetailed annual work plans with clear performance indicators and assigned responsibilities for their achievement will be developed. Key indicators that will inform management decision making will be identified and the frequency of reporting on these indicators will be determined. This will form the foundation of the Monitoring and Evaluation (M & E) system.
7.2.4 Data and Information Collection ProceduresElaborate data and information collection templates and procedures will be developed to capture performance as per the indicators and report appropriately to management. These procedures will be incorporated into existing and functional operating manuals so that they become part of regular work.
7.2.5 Regular/Periodic Meetings Monthly Review Meetings at the Directorate/Divisional/Departmental levels will be scheduled to en-sure implementation is on track. Quarterly review meetings at the Management level will be sched-uled to get and give feedback on pertinent performance indicators. The overall oversight of the Strategic Plan and its implementation is a critical role of the Board of Directors. Therefore progress reporting will be an Agenda Item in all Board Meetings.
7.3 Monitoring Tools NHIF will apply both quantitative and qualitative tools to monitor performance of respective De-partments. The major techniques of monitoring and evaluation that shall be used are customer satisfaction, employee satisfaction surveys, cost-benefit analysis, variance analysis, ratio analysis and budgets.
7.3.1 Cost-Benefit AnalysisCost benefit analysis shall be done from time to time to evaluate the various activities and proj-ects. This shall assist management in decision making and on what to prioritize in terms of strategy implementation.
7.3.2 Variance AnalysisThe Management will compare the performance targets with the actual results to reveal any varianc-es. As a consequence of variance analysis and identification of causes, NHIF shall take appropriate remedial actions.
45 38
49
7.3.3 Ratio AnalysisPertinent ratios will be calculated quarterly, semi-annually and annually and the actual results com-pared with the target ratios. The differences between target and actual ratios will be identified and analyzed. This analysis will invoke appropriate remedial actions. Trend analysis of the ratios will also be depicted to more clearly show which way the performance is heading. 7.3.4 Budgetary ControlUnder this monitoring and evaluation process, actual revenues and expenses will continually be checked against planned results and variances investigated. If necessary, action plans will be changed so that they are brought in line with the budgeted results or the budget will be amended to take account of new developments.
7.3.5 Customer Satisfaction Surveys NHIF shall undertake internal customer satisfaction surveys as well as independent survey to estab-lish customer perceptions and determine Customer satisfaction index.
7.3.6 Employee Satisfaction SurveysNHIF shall undertake annual employee satisfaction surveys to determine the satisfaction levels of its staff and draw recommendations for implementation towards improving their welfare.
7.4 Progress ReportsProgress reports will regularly be prepared by the implementing Departments as per the budgetary cycles. The Plan Implementation Team will act as the internal consultant to assist the Departments in preparation and presentation of reports. The reports will describe actions taken by the Depart-ments toward achieving specific outcomes and strategies of the Plan and may include costs, bene-fits, performance measures, and progress to date.
7.5 Annual Review and End Term EvaluationAt the end of each financial year, a report will be produced and released to the public. An end term review will also be carried out at the end of the financial year 2022/23 and summarize the results in terms of lessons learnt. These lessons will inform the next planning cycle and the same shared with both internal and external stakeholders.
7.6 Linking M & E to Annual Performance Contracts and Appraisals To be action-oriented, plans will translate to work. The Fund’s performance objectives (targets) will therefore be translated into Directorate objectives. The latter will in turn be translated into Departmental, Sectional and Individual objectives and targets. Implementation will be in line with the Performance Contracting guidelines. The performance contract targets will inform NHIF staff performance appraisal and reward systems.
7.7 Monitoring & Evaluation FrameworkThe Monitoring & Evaluation framework will provide direction on performance monitoring & evaluation of the 2018-2022 Strategic Plan. The framework shall guide decision making by categorizing the implications of progress or lack of it being made by the organization and provide information on progress and results.
The monitoring and reporting will be based on the balance scorecard system. The relevant sources of information for reporting will be system reports, financial management reports, surveys, special evaluations and researches. The reporting and learning activities will follow the sequence elaborated in the table:
46 39
5050
Reporting Timing Learning Activities Responsibility
1. Monthly monitoring reports • 1st -10th Every Month
• To check progress of outputs and measure level of indicator achievement against targets
• To encourage departmental & branch self-evaluations and implement self-corrective actions
• To continuously hold monthly Work Improvement Team Meetings within Directorates/Departments that address progress of outputs
• Directors• Branch Managers• Manager Strategy &
Planning
2. Quarterly evaluation re-ports & Management forums
• 10th -15th October, January, April, July
• To gauge achievement of outputs on primary activities and secondary activities over the period of 3months and to monitor the trend
• To recommend areas of action, focus and priority
• Departmental self-evaluation and implementation of corrective actions
• To hold Senior Management Meetings to check organizational performance
• Quarterly evaluation performance reports to the Ministry of Health
• Directors• Branch Managers• Manager Strategy &
Planning
3. Annual review of the Strategic Plan & Management forums
• 10th -15th July
• To monitor trend of performance over one year
• To check the progress of indicators against targets, outputs and check if strategic objectives remain relevant
• To recommend course of action to address challenges and set backs
• Directors• Branch Managers• Manager Strategy &
Planning
4.Midterm evaluation of the Strategic Plan in 2020 • July-Sept 2020
• To review progress towards achiev-ing outputs and the strategic goals against targets, and to monitor trend of past period
• To Assess the appropriateness of overall strategy
• To Identify priority areas that re-quire greater focus within remain-ing strategic period
• To Develop recommendations to be effected within remaining period
• Directors• Branch Managers• Manager Strategy &
Planning
5.End term Evaluation of the Strategic Plan in 2022 • July-Sept 2022
• To assess the overall strategy within period 2018-2022
• To identify milestones achieved, challenges and outputs that were not achieved
• Lessons learnt from the strategic period
• To identify areas of focus and priority to be effected in the next strategic period.
• Design the next strategic plan
• Directors• Branch Managers• Manager Strategy &
Planning
47 40
51
7.8 The Monitoring & Evaluation ModelThe M & E model details the performance monitoring and evaluation cycle for the strategic plan period running across five years. It enumerates a five point step on M & E where the evaluation recommendations feed into the future and subsequent objectives and strategies.
47 41
5252
Ann
ex 1
:
Stra
tegy
Im
plem
enta
tion
(A
ctio
n Pl
an)
Mat
rice
s
STRA
TEG
IC I
SSU
E 1:
IN
CREA
SE Q
UA
LITY
HEA
LTH
IN
SURA
NCE
CO
VERA
GE
OBJ
ECTI
VE 1
: IN
CREA
SE N
UM
BER
OF
PRIN
CIPA
L M
EMBE
RS F
ROM
7 M
ILLI
ON
TO
19
MIL
LIO
N B
Y 20
22
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
ePe
rfor
man
ce
Indi
cato
rBa
selin
e
Targ
et
for
Year
1
(201
8/19
)
Targ
et
for
Year
2
(201
9/20
)
Targ
et f
orYe
ar 3
(2
020/
21)
Targ
et f
or
Year
4
(202
1/22
)
Targ
et
for
Yea
r 5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
et
(Ksh
s M
illio
n)Re
spon
sibi
lity
1.1
Enha
nce
com
plia
nce
wit
h m
anda
tory
co
ntri
buti
ons
1.1.
1 Re
-eng
inee
r th
e co
mpl
ianc
e pr
oces
s
End
of
Year
1Re
-eng
inee
red
proc
ess
Re-e
ngin
eere
d pr
oces
s Re
port
5 M
illio
nDO
QA
1.1.
2 Pa
rtne
r w
ith
Nat
iona
l &
Cou
nty
gove
rnm
ents
and
pr
ivat
e se
ctor
to
enh
ance
co
mpl
ianc
e
Annu
ally
%30
%50
%80
% 90
% 90
% 90
% 9
0%30
Mill
ion
DOQ
A
1.1.
3 In
tegr
ate
wit
h ot
her
gove
rnm
ent
agen
cies
for
dat
a m
inin
g
Annu
ally
N
o.3
45
67
77
60
Mill
ion
DOQ
A
1.2
Ado
pt
inno
vati
ve a
nd
effici
ent
acce
ss
poin
ts t
o N
HIF
Se
rvic
es
1.2.
1 Re
crui
tmen
t of
ne
w m
embe
rsAn
nual
lyTo
tals
of
mem
-be
r re
crui
tmen
t7.
65M
9.9M
12.9
M16
M19
.2M
19.7
M19
.7M
48 42
53
STRA
TEG
IC I
SSU
E 1:
IN
CREA
SE Q
UA
LITY
HEA
LTH
IN
SURA
NCE
CO
VERA
GE
OBJ
ECTI
VE 1
: IN
CREA
SE N
UM
BER
OF
PRIN
CIPA
L M
EMBE
RS F
ROM
7 M
ILLI
ON
TO
19
MIL
LIO
N B
Y 20
22
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
ePe
rfor
man
ce
Indi
cato
rBa
selin
e
Targ
et
for
Year
1
(201
8/19
)
Targ
et
for
Year
2
(201
9/20
)
Targ
et f
orYe
ar 3
(2
020/
21)
Targ
et f
or
Year
4
(202
1/22
)
Targ
et
for
Yea
r 5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
et
(Ksh
s M
illio
n)Re
spon
sibi
lity
1.2.
2 De
velo
p in
nova
tive
and
co
st e
ffec
tive
ac
cess
poi
nts
End
of Y
ear
1 an
d 3
No.
145
11
2
DOQ
AH
-HRA
DSPM
1.2.
3 Cr
eate
aw
aren
ess
on t
he
acce
ss p
oint
sAn
nual
lyN
o. (
Uti
lizat
ion)
Awar
enes
s In
dex
X%20
0,00
0
500,
000
X+5
200,
000
500,
000
1M X+5
DSPM
HO
CC
1.3
Enha
nce
stra
tegi
c m
arke
ting
an
d pu
blic
ed
ucat
ion
1.3.
1 Es
tabl
ish
Bran
d eq
uity
in
dex
End
of
Year
1
Repo
rtBr
and
Equi
ty
Repo
rt
2
Mill
ion
DSPM
%X
1.3.
2 De
velo
p an
int
egra
t -ed
mar
keti
ng
com
mun
icat
ion
(IM
C) a
nd p
ublic
ed
ucat
ion
plan
End
of
Year
1
IMC
Plan
Publ
ic e
duca
-ti
on p
lan
and
tool
s
50
Mill
ion
HO
CC
1.3.
3 En
gage
st
rate
gic
part
ner -
ship
s fo
r m
arke
t-in
g co
mm
unic
a-ti
on a
nd p
ublic
ed
ucat
ion
Annu
ally
No.
11
11
15
HO
CC
49 43
5454
STRA
TEG
IC I
SSU
E 1:
IN
CREA
SE Q
UA
LITY
HEA
LTH
IN
SURA
NCE
CO
VERA
GE
OBJ
ECTI
VE 1
: IN
CREA
SE N
UM
BER
OF
PRIN
CIPA
L M
EMBE
RS F
ROM
7 M
ILLI
ON
TO
19
MIL
LIO
N B
Y 20
22
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
ePe
rfor
man
ce
Indi
cato
rBa
selin
e
Targ
et
for
Year
1
(201
8/19
)
Targ
et
for
Year
2
(201
9/20
)
Targ
et f
orYe
ar 3
(2
020/
21)
Targ
et f
or Y
ear
4 (2
021/
22)
Targ
et f
or
Year
5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
et
(Ksh
s M
illio
n)
Resp
onsi
-bi
lity
1.4
Att
ain
and
sust
ain
70%
mem
ber
rete
ntio
n ra
te
1.4.
1 Es
tabl
ish
driv
ers
of
cust
omer
sa
tisf
acti
on
End
of
Year
1Re
port
Repo
rt
50
Mill
ion
DSPM
1.4.
2 En
hanc
e th
e cu
stom
er
loya
lty
pro -
gram
me
End
of
Year
1
Cust
omer
Lo
yalt
y po
licy
Appr
oved
Cu
stom
er
Loya
lty
Polic
y
DSPM
End
of
Year
2
and
4
No.
of
Pro-
gram
mes
12
2
1.4.
3 Ac
quir
e 10
002:
2014
Qua
l-it
y M
anag
emen
t on
Cus
tom
er
sati
sfac
tion
End
of
Year
1,
2,
and
3
Cert
ifica
tion
20%
50%
100%
Cert
ifi-
cati
onDS
PM
1.5
Enha
nce
the
exis
ting
be
nefit
pa
ckag
es
and
deve
lop
a ne
w
prod
uct
mix
1.5.
1 In
vest
in
mar
keti
ng
rese
arch
and
pr
oduc
t de
velo
p -m
ent
Year
1
and
con-
tinuo
us
Rese
arch
Re
port
1
23
45
5DO
QA
1.5.
2 Ed
ucat
e cu
stom
ers
on e
x -is
ting
pro
duct
s/be
nefit
pac
kage
s
End
of
Year
1,2
,3
& 4
Educ
atio
n Pl
anEd
ucat
ion
Plan
Impl
emen
tati
on
Repo
rtEd
ucat
ion
Plan
Impl
emen
tati
on
Repo
rtDO
QA
1.5.
3 Im
prov
e ac
cess
ibili
ty o
f be
nefit
pac
kage
s
End
of
Year
2
and
annu
ally
th
erea
fter
Faci
litie
s 5
00 7
0010
00 1
,000
3,2
00DO
QA
44
55
STRA
TEG
IC I
SSU
E 1:
IN
CREA
SE Q
UA
LITY
HEA
LTH
IN
SURA
NCE
CO
VERA
GE
OBJ
ECTI
VE 1
: T
o in
crea
se n
umbe
r of
pri
ncip
al m
embe
rs f
rom
7 m
illio
n to
19
mill
ion
by 2
022
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
ePe
rfor
man
ce
Indi
cato
rBa
selin
e Ta
rget
fo
r Y
ear
1 (2
018/
19)
Targ
et f
or
Year
2
(201
9/20
)
Targ
et f
or
Year
3
(202
0/21
)
Targ
et f
orYe
ar 4
(2
021/
22)
Targ
et f
or
Year
5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
etRe
spon
sibi
lity
2.1
Impr
ove
acce
ssib
ility
of
ben
efit
pack
ages
2.1.
1 D
evel
op a
nd
impl
emen
t a
stan
dard
be
nefit
pac
kage
End
of
Year
1St
d Be
nefit
pa
ckag
eSt
anda
rd B
en-
efit
Pack
age
DOQ
A
2.1.
2 Re
view
fac
ility
as
sess
men
t to
ol t
o al
ign
it t
o pr
imar
y he
alth
care
pr
ovid
ers
End
of
Year
1Re
view
ed
Tool
Revi
ewed
as
sess
men
t to
ol
DOQ
A
2.1.
3 De
clar
e an
d co
ntra
ct p
rim
ary
heal
thca
re f
acili
ties
End
of
Year
2
and
annu
ally
th
erea
fter
500
700
1000
1,0
00 3
,200
DOQ
A
2.1.
4 Re
view
hea
lth
prov
ider
s ne
twor
k in
lin
e w
ith
bene
fit
pack
ages
Revi
ew
prov
ider
ne
twor
k re
port
Revi
ewed
Re
port
DOQ
A
2.1.
5 Im
plem
ent
reco
mm
enda
tion
s of
re
view
rep
ort
End
of
Year
1
and
2
50%
50%
100%
DOQ
A
2.1.
6 Pr
omot
e in
vest
men
ts i
n he
alth
care
ser
vice
s in
un
ders
erve
d ar
eas
End
of
Year
2
to 5
No.
of
new
fa
cilit
ies
in t
arge
ted
area
s
24
610
DOQ
A
45
5656
STRA
TEG
IC I
SSU
E 1:
IN
CREA
SE Q
UA
LITY
HEA
LTH
IN
SURA
NCE
CO
VERA
GE
OBJ
ECTI
VE 1
: T
o i
ncre
ase
num
ber
of p
rinc
ipal
mem
bers
fro
m 7
mill
ion
to 1
9 m
illio
n by
202
2
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
ePe
rfor
man
ce
Indi
cato
rBa
selin
e Ta
rget
for
Ye
ar 1
(2
018/
19)
Targ
et f
or
Year
2
(201
9/20
)
Targ
et f
or
Year
3
(202
0/21
)
Targ
et f
orYe
ar 4
(2
021/
22)
Targ
et f
or
Year
5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
etRe
spon
sibi
lity
2.1.
7 De
velo
p a
tele
med
icin
e po
licy
End
of
Year
1Ap
prov
ed p
olic
yAp
prov
ed
polic
yDO
QA
DSPM
2.1.
8 Pa
rtne
r w
ith
tele
med
icin
e/m
-he
alth
to
expa
nd
acce
ss
End
of
Year
2
to 5
No.
of
peop
le
acce
ssin
g1,
000
5,0
00 1
0,00
0 1
5,00
0 3
1,00
0
No.
of p
artn
ers
DO
QA
2.1.
9 Pr
omot
e us
e of
mob
ile c
linic
sAn
nual
lyN
o. o
f cl
inic
s5
1015
2025
25
2.1.
10 P
artn
er a
nd
reco
gniz
e sk
illed
co
mm
unit
y m
idw
ives
End
of
Year
2
to 5
Num
ber
2550
7510
0
2.1.
11 D
evel
op
a po
licy
on
enga
gem
ent
wit
h ph
arm
aceu
tica
l co
mpa
nies
End
of
Year
1
Appr
oved
Pol
icy
Appr
oved
po
licy
DOQ
A
2.1.
12
Ope
rati
onal
ize
the
Polic
y
End
of
Year
2
and
annu
ally
th
erea
fter
No.
of
Part
ner-
ship
s1
23
44
250
Mill
ion
DOQ
A
52 46
57
STRA
TEG
IC I
SSU
E 1:
IN
CREA
SE Q
UA
LITY
HEA
LTH
IN
SURA
NCE
CO
VERA
GE
OBJ
ECTI
VE 1
: T
o i
ncre
ase
num
ber
of p
rinc
ipal
mem
bers
fro
m 7
mill
ion
to 1
9 m
illio
n by
202
2
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
ePe
rfor
man
ce
Indi
cato
rBa
selin
e Ta
rget
for
Ye
ar 1
(2
018/
19)
Targ
et f
or
Year
2
(201
9/20
)
Targ
et f
or
Year
3
(202
0/21
)
Targ
et f
orYe
ar 4
(2
021/
22)
Targ
et f
or
Year
5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
etRe
spon
sibi
lity
2.1.
13 L
aunc
h &
im
plan
tati
on o
f m
ulti
-tie
red
bene
fits
BY Y
R 1
Laun
chDO
QA
2.2
Enha
nce
mar
keti
ng
rese
arch
an
d pr
oduc
t de
velo
p-m
ent
2.2.
1 Co
nduc
t ap
prop
riat
e m
arke
t re
sear
ch (
in-h
ouse
, co
llabo
rati
ve a
nd
outs
ourc
ing)
Year
1
and
con -
tinu
ous
Rese
arch
Rep
ort
12
34
55
DSPM
2.2.
2 Im
plem
ent
reco
mm
enda
tion
s of
m
arke
t re
sear
ch
Y2 –
Y4
%%
%%
%%
150
Mill
ion
ALL
DIRE
CTO
R -AT
ES
2.3
Educ
ate
cust
omer
s on
new
ex
isti
ng
prod
ucts
/be
nefit
pa
ckag
es
2.3.
1 Re
view
and
st
anda
rdiz
e In
for-
mat
ion,
Edu
cati
on &
Co
mm
unic
atio
n (I
EC)
Mat
eria
ls
End
of
Year
1
& 3
Repo
rt
Re
port
Repo
rt
DO
QA
DSPM
2.3.
2 De
velo
p an
d im
plem
ent
an e
du-
cati
on a
nd c
omm
u-ni
cati
on p
lan
End
of
Year
1,2
,3
& 4
Educ
atio
n Pl
an
Educ
atio
n Pl
anIm
ple-
men
tati
on
Repo
rt
Educ
atio
n Pl
anIm
ple-
men
tati
on
Repo
rt
DS
PM H
CC
2.3.
3 Im
prov
e kn
owle
dge
base
of
cust
omer
s on
pro
d -uc
ts a
nd r
ight
s
Annu
ally
Cu
stom
er
know
ledg
e on
pr
oduc
ts a
nd
righ
ts i
ndex
x80
% 85
%90
%95
%10
0%DS
PM
Cust
omer
sa
tisf
ac-
tion
lev
el
77%
79%
81%
82%
84%
85%
2,00
0 M
illio
nDS
PM
47
5858
IS
SUE
2: E
NH
AN
CE F
INA
NCI
AL
BASE
OBJ
ECTI
VE
1: :
To
enha
nce
reve
nue
infl
ow a
nd i
ts u
tiliz
atio
n
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
ePe
rfor
man
ce
Indi
cato
rBa
selin
e Ta
rget
for
Ye
ar 1
(2
018/
19)
Targ
et
for
Yea
r 2
(201
9/20
)
Targ
et f
or
Year
3
(202
0/21
)
Targ
et f
orYe
ar 4
(2
021/
22)
Targ
et f
or
Year
5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
etRe
spon
sibi
lity
3.1
Div
ersi
fy
and
enha
nce
sour
ces
of
fund
ing
in
line
wit
h so
cial
hea
lth
insu
ranc
e pr
inci
ples
3.1.
1 In
crea
se
cont
ribu
tion
s fr
om 4
7B t
o 75
.97B
Annu
ally
Amou
nt R
aise
d50
B65
.785
B65
.976
B70
.734
B77
.202
B83
.736
B36
3.43
3B60
M
illio
nDO
QA
DFI
DSPM
CS/H
LS
a.Fo
rmal
Se
ctor
Annu
ally
Amou
nt R
aise
d29
.724
B30
.09B
31.2
77B
33.0
88B
35.3
8B37
.385
B16
7.23
3BDO
QA
b.In
form
al
Sect
orAn
nual
lyAm
ount
Rai
sed
6.92
B14
.46B
18.8
47B
20.2
11B
22.6
36B
25.2
54B
101.
413B
DOQ
A
c.Su
bsid
ies
Annu
ally
Amou
nt R
aise
d1.
21B
7.33
1B7.
331B
DOQ
ADF
I
d. L
inda
M
ama
Annu
ally
Amou
nt R
aise
d3.
8B4.
29B
--
--
4.29
BDO
QA
DFI
3.2
Adop
t st
rate
gic
busi
ness
de
velo
pmen
t to
inc
reas
e m
anag
ed
sche
mes
and
ag
greg
ated
gr
oups
in
the
info
rmal
se
ctor
3.2.
1 Cr
eate
aw
aren
ess
for
new
sch
emes
an
d so
licit
fo
r in
sura
nce
busi
ness
fro
m
orga
niza
tion
s/en
titi
es
End
of
Year
2
and
4
Appr
oved
Co
mm
unic
atio
n Pl
an &
IEC
m
ater
ials
; N
o. o
f gr
oups
re
ache
d;
Awar
enes
s le
vels
Com
mun
icat
ion
Plan
& I
EC
Mat
eria
lsSu
rvey
rep
ort
Com
mun
icat
ion
Plan
& I
EC
Mat
eria
lsSu
rvey
rep
ort
DSPM
HO
CC
48
59
IS
SUE
2: E
NH
AN
CE F
INA
NCI
AL
BASE
OBJ
ECTI
VE
1: :
To
enha
nce
reve
nue
infl
ow a
nd i
ts u
tiliz
atio
n
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
ePe
rfor
man
ce
Indi
cato
rBa
selin
e Ta
rget
for
Ye
ar 1
(2
018/
19)
Targ
et
for
Yea
r 2
(201
9/20
)
Targ
et f
or
Year
3
(202
0/21
)
Targ
et f
orYe
ar 4
(2
021/
22)
Targ
et f
or
Year
5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
etRe
spon
sibi
lity
Annu
ally
no.
of n
ew
sche
mes
10
2030
4050
50
DOQ
A
Annu
ally
reve
nue
of A
ll sc
hem
es
8.3B
21.2
25B
15.8
50B
17.4
35B
19.1
78B
21.0
95B
83.1
54BB
DOQ
A
3.2.
2 Co
nduc
t m
arke
t st
udy
and
epid
emio
logi
c da
ta r
evie
ws
of t
arge
ted
grou
ps
End
of
Year
1
and
3
Mar
ket
Stud
y re
port
Mar
ket
Stud
y re
port
Mar
ket
Stud
y re
port
80
Mill
ion
DSPM
3.2.
3 Co
nduc
t ac
tuar
ial
revi
ews
and
desi
gn/r
evie
w
prod
ucts
End
of
Year
2
and
4
Appr
oved
pr
oduc
tsN
ew/R
evie
wed
pr
oduc
tsN
ew/R
evie
wed
pr
oduc
tsDF
I
49
IS
SUE
2: E
NH
AN
CE F
INA
NCI
AL
BASE
OBJ
ECTI
VE
1: :
To
enha
nce
reve
nue
infl
ow a
nd i
ts u
tiliz
atio
n
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
ePe
rfor
man
ce
Indi
cato
rBa
selin
e Ta
rget
for
Ye
ar 1
(2
018/
19)
Targ
et
for
Yea
r 2
(201
9/20
)
Targ
et f
or
Year
3
(202
0/21
)
Targ
et f
orYe
ar 4
(2
021/
22)
Targ
et f
or
Year
5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
etRe
spon
sibi
lity
3.2.
4 Cr
eate
aw
aren
ess
for
new
sch
emes
an
d so
licit
fo
r in
sura
nce
busi
ness
fro
m
orga
niza
tion
s/en
titi
es
End
of
Year
2
and
4
Appr
oved
Co
mm
unic
atio
n Pl
an &
IEC
ma -
teri
als;
No.
of
grou
ps r
each
ed;
Awar
enes
s le
vels
Com
mun
icat
ion
Plan
& I
EC
Mat
eria
lsSu
rvey
rep
ort
Com
mun
icat
ion
Plan
& I
EC
Mat
eria
lsSu
rvey
rep
ort
DSPM
HO
CC
Annu
ally
no.
of n
ew
sche
mes
1020
3040
50 5
0DO
QA
Annu
ally
reve
nue
of t
he
sche
mes
8.
3B21
.225
B15
.850
B17
.435
B19
.178
B21
.095
B83
.154
BBDO
QA
3.3
Enha
nce
heal
thca
re
finan
cing
on
indi
gent
s by
th
e Co
unty
G
over
nmen
ts
3.3.
1 Cr
eate
aw
aren
ess
and
educ
ate
coun
ty g
ovts
on
the
nee
d to
con
trib
ute
to c
over
the
po
or a
nd
info
rmal
se
ctor
po
pula
tion
s th
roug
h N
HIF
End
of
Year
1
No.
of
Coun
ties
se
nsit
ized
4747
120
Mill
ion
DOQ
A DS
PM
50
IS
SUE
2: E
NH
AN
CE F
INA
NCI
AL
BASE
OBJ
ECTI
VE
1:
To e
nhan
ce r
even
ue i
nflow
and
its
uti
lizat
ion
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
ePe
rfor
man
ce
Indi
cato
rBa
selin
e Ta
rget
fo
r Y
ear
1 (2
018/
19)
Targ
et f
or
Year
2
(201
9/20
)
Targ
et f
or
Year
3
(202
0/21
)
Targ
et f
orYe
ar 4
(2
021/
22)
Targ
et f
or
Year
5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
etRe
spon
sibi
lity
3.3.
2 De
velo
p an
d im
plem
ent
part
ners
hip
wit
h co
unty
gov
ts t
o ex
pand
cov
erag
e fo
r th
e in
form
al s
ecto
r an
d in
dige
nts
End
of
Year
2
to 5
Part
ners
hip
agre
e -m
ents
1410
20
3033
3340
M
illio
nDO
QA
DSPM
3.3.
3 Id
enti
fy g
roup
s fo
r fu
ll/pa
rtia
l su
bsid
y an
d en
gage
G
over
nmen
t, C
DF
and
part
ners
End
of
Year
1
Subm
itte
d Re
port
on
gro
ups
to b
e su
bsid
ized
Repo
rt o
n go
vt a
nd
part
ner
enga
gem
ents
Repo
rt80
M
illio
nDO
QA
DFI
HO
CC
56 51
STRA
TEG
IC I
SSU
E 1:
IN
CREA
SE Q
UA
LITY
HEA
LTH
IN
SURA
NCE
CO
VERA
GE
OBJ
ECTI
VE 1
: T
o in
crea
se n
umbe
r of
pri
ncip
al m
embe
rs f
rom
7 m
illio
n to
19
mill
ion
by 2
022
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
ePe
rfor
man
ce
Indi
cato
rBa
selin
e Ta
rget
for
Ye
ar 1
(2
018/
19)
Targ
et f
or
Year
2
(201
9/20
)
Targ
et f
or
Year
3
(202
0/21
)
Targ
et f
orYe
ar 4
(2
021/
22)
Targ
et f
or
Year
5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
etRe
spon
sibi
lity
4.1
Redu
ce
adm
inis
trat
ion
expe
nse
to t
otal
co
ntri
buti
on r
atio
fr
om 1
7 to
no
mor
e th
an 1
5 pe
rcen
t
4.1.
1 id
enti
fy k
ey
adm
inis
trat
ive
cost
dr
iver
s
End
of
Year
1 C
ost
Anal
ysis
re
port
Anal
ysis
re
port
0.2
Mill
ion
DFI
DHR&
A
4.1.
2 Im
plem
ent
cost
re
duct
ion
mea
sure
s ba
sed
on t
he
iden
tifie
d ar
eas
(e.g
. pr
oces
ses,
peo
ple,
IC
T, p
rocu
rem
ent
e.t.
c.)
Annu
ally
A
dmin
cos
ts
rati
o 1
7%17
% 1
6% 1
6% 1
5% 1
3%D
FI
4.2
Enha
nce
stra
tegi
c pu
rcha
sing
of
bene
fits
from
he
alth
care
pr
ovid
ers
4.2.
1 Re
view
the
de
clar
atio
n an
d co
ntra
ctin
g sy
stem
an
d to
ols
to f
ocus
m
ore
on p
rim
ary
heal
th c
are
and
outc
omes
End
of
Year
1•
Revi
ewed
to
ols
&
syst
ems
• Re
vise
d pr
ovid
er
cont
ract
s
Revi
sed
syst
ems
and
tool
s
DOQ
A
4.2.
2 Co
nduc
t co
stin
g of
ser
vice
s ac
ross
va
riou
s le
vels
of
care
to
inf
orm
ben
efit
desi
gn a
nd p
aym
ent
mec
hani
sm
End
of
Year
1Co
stin
g re
port
Cost
ing
repo
rtDF
I
57 52
STRA
TEG
IC I
SSU
E 1:
IN
CREA
SE Q
UA
LITY
HEA
LTH
IN
SURA
NCE
CO
VERA
GE
OBJ
ECTI
VE 1
: T
o in
crea
se n
umbe
r of
pri
ncip
al m
embe
rs f
rom
7 m
illio
n to
19
mill
ion
by 2
022
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
ePe
rfor
man
ce
Indi
cato
rBa
selin
e Ta
rget
fo
r Y
ear
1 (2
018/
19)
Targ
et
for
Yea
r 2
(201
9/20
)
Targ
et f
or
Year
3
(202
0/21
)
Targ
et f
orYe
ar 4
(2
021/
22)
Targ
et f
or
Year
5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
etRe
spon
sibi
lity
4.2.
3 De
ploy
in
nova
tive
and
effi
cien
t PP
Ms
appr
opri
ate
to
diff
eren
t be
nefit
pa
ckag
es a
nd l
evel
s of
car
e
Annu
ally
Re
vise
d PP
M’s
Sy
stem
s Re
vise
d PP
Ms'
syst
ems
Revi
sed
PPM
s' sy
s -te
ms
Revi
sed
PPM
s' sy
stem
s
Revi
sed
PPM
s' sy
stem
s
Revi
sed
PPM
s' sy
stem
s
DFI
4.2.
4 St
reng
then
be
nefit
uti
lizat
ion/
Case
man
agem
ent
Annu
ally
Av
erag
e co
st
per
clai
m
cate
gory
xy
cz
w
30
Mill
ion
DFI
Annu
ally
Pa
y ou
t rat
ion
betw
een
65-
75%
78%
79%
83%
85%
86%
88%
DOQ
A
4.3
Stre
ngth
en
inte
rnal
co
ntro
ls
4.3.
1 Re
view
and
im
plem
ent
finan
ce
polic
ies,
reg
ulat
ions
an
d m
anua
ls
(Int
erna
l &
Ext
erna
l)
Year
1
and
2Re
vise
d po
licie
s an
d m
anua
ls i
m-
plem
ente
d
Revi
sed
polic
ies
and
man
uals
New
/Rev
ised
po
licie
s im
-pl
emen
ted
1.2
M
illio
nDF
IH
-IA
DHR&
AH
-ICT
4.3.
2 Re
view
, up
date
an
d im
plem
ent
the
Risk
and
Aud
it p
ol-
icy
regu
lati
ons
and
man
uals
Year
1
and
2Re
vise
d po
licie
s an
d m
anua
ls
Revi
sed
polic
ies
and
man
uals
Revi
sed
polic
ies
and
man
uals
im
-pl
emen
ted
DFI
H-I
ADH
R&A
H-I
CT
4.3.
3 H
arm
oniz
e Fi
nanc
e/Au
dit/
Risk
w
ith
Info
rmat
ion
secu
rity
pol
icie
s an
d sy
stem
s
End
of
Year
1Sy
nchr
oniz
ed
finan
ce,
risk
, au
dit
&
ICT
secu
rity
sy
stem
Sync
hron
ized
co
ntro
l sy
stem
s
2 M
illio
n
DFI
H-I
ADH
R&A
H-I
CT
58 53
STRA
TEG
IC I
SSU
E 1:
IN
CREA
SE Q
UA
LITY
HEA
LTH
IN
SURA
NCE
CO
VERA
GE
OBJ
ECTI
VE 1
: T
o in
crea
se n
umbe
r of
pri
ncip
al m
embe
rs f
rom
7 m
illio
n to
19
mill
ion
by 2
022
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
ePe
rfor
man
ce
Indi
cato
rBa
selin
e Ta
rget
fo
r Y
ear
1 (2
018/
19)
Targ
et
for
Yea
r 2
(201
9/20
)
Targ
et f
or
Year
3
(202
0/21
)
Targ
et f
orYe
ar 4
(2
021/
22)
Targ
et f
or
Year
5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
etRe
spon
sibi
lity
4.4
Colla
b -or
ate
wit
h co
mpl
e-m
enta
ry
insu
ranc
e sc
hem
es t
o en
hanc
e se
r-vi
ce d
eliv
ery
4.4.
1 De
velo
p an
d ag
ree
on c
o-in
sur -
ance
mod
els
wit
h pr
ivat
e/co
mm
unit
y in
sura
nces
in
clai
ms’
se
ttle
men
t
Year
1
and
2Pa
rtne
rshi
p ag
reem
ent
Part
ners
hip
agre
emen
tPa
rtne
rshi
p ag
reem
ent
impl
emen
ted
OQ
ADO
QA
4.4.
2 De
velo
p an
d im
plem
ent
an i
ndus
-tr
y-w
ide
init
iati
ve
to t
ackl
e he
alth
in
sura
nce
frau
d/ab
use/
mis
use
Year
1
and
2Jo
int
frau
d m
itig
atio
n pl
an
Frau
d m
iti-
gati
on p
lan/
inte
rven
tion
s
Impl
emen
ted
Frau
d m
iti-
gatio
n pl
an/
inte
rven
tions
2
Mill
ion
OQ
ADO
QA
4.5
Ensu
re
prud
ent
inve
stm
ent
of fi
nanc
ial
reso
urce
s
4.5.
1 Re
vise
and
im
-pl
emen
t in
vest
men
t st
rate
gy
End
of
Year
1Re
vise
d In
vest
men
t st
rate
gy
Upd
ated
in
vest
men
t st
rate
gy
DOQ
A
4.5.
2 Re
view
and
op
tim
ize
curr
ent
inve
stm
ent
clas
ses/
asse
ts
Annu
ally
%
retu
rn o
n in
vest
men
tsX%
(X+1
)%(X
+2)%
(X+3
)%(X
+4)%
(X+5
)%
0.
5 M
illio
n
DFI
4.5.
3 De
velo
p ne
w
inve
stm
ent
oppo
r -tu
niti
es
Annu
ally
N
umbe
r of
ne
w i
nves
t-m
ent
oppo
r-tu
niti
es
2
44
4 5
19
DFI
59 54
STRA
TEG
IC I
SSU
E 3:
EN
HA
NCE
IN
STIT
UTI
ON
AL
CAPA
CITY
OBJ
ECTI
VE
1: T
o en
hanc
e co
mpl
ianc
e to
goo
d co
rpor
ate
gove
rnan
ce
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
ePe
rfor
man
ce
Indi
cato
rBa
selin
e Ta
rget
fo
r Y
ear
1 (2
018/
19)
Targ
et
for
Yea
r 2
(201
9/20
)
Targ
et
for
Year
3
(202
0/21
)
Targ
et
for
Year
4
(202
1/22
)
Targ
et f
or
Year
5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
etRe
spon
sibi
lity
5.1
Enha
nce
lega
l an
d re
gula
tory
fr
amew
ork
5.1.
1 Co
nduc
t le
gal
and
regu
lato
ry
audi
t in
NH
IF
Valu
e Ch
ain
Year
1Im
plem
enta
-ti
on R
epor
tRe
port
20
Mill
ion
Corp
orat
ion
Secr
etar
y
5.1.
2 Se
cure
st
akeh
olde
r su
ppor
t in
le
gal
and
regu
lato
ry
proc
ess
Year
2St
akeh
olde
r en
gage
men
t re
port
Repo
rt80
M
illio
n
Corp
orat
ion
Secr
etar
yDS
PMDO
QA
5.2
Inst
itut
iona
lize
an e
ffec
tive
m
anag
emen
t sy
stem
5.2.
1 De
velo
p a
corp
orat
e cr
isis
m
anag
emen
t fr
amew
ork
End
of
Year
1
Cris
is
corp
orat
e m
anag
emen
t fr
amew
ork
Cris
is
corp
orat
e m
anag
emen
t fr
amew
ork
oper
atio
nal
H-H
R&A
DSP
M C
S
5.2.
2 M
ains
trea
m
Risk
M
anag
emen
t Sy
stem
Q2,
Y1
Eva
luat
ion
repo
rt E
valu
atio
n re
port
10
Mill
ion
DFI
5.2.
3 En
sure
co
mpl
ianc
e w
ith
good
co
rpor
ate
gove
rnan
cean
d st
rate
gic
lead
ersh
ip.
End
of
Year
1
& 2
No.
of
Boar
d m
embe
rs &
m
anag
emen
t tr
aine
d
2041
35
Mill
ion
CEO
5.3
Incu
lcat
e a
perf
orm
ance
or
ient
ed
corp
orat
e cu
ltur
e
5.3.
1 Im
plem
ent
the
new
BS
C sy
stem
, tr
ain
staff
an
d m
onit
or
utili
zati
on a
t bo
th c
orpo
rate
&
ind
ivid
ual
leve
l
Q2
– Q
4Y1
to
3 N
o. o
f st
aff
trai
ned
300
600
1000
80
Mill
ion
H-H
R&A
DSPM
60 55
STRA
TEG
IC I
SSU
E 3:
EN
HA
NCE
IN
STIT
UTI
ON
AL
CAPA
CITY
OBJ
ECTI
VE
1: T
o en
hanc
e co
mpl
ianc
e to
goo
d co
rpor
ate
gove
rnan
ce
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
ePe
rfor
man
ce
Indi
cato
rBa
selin
e Ta
rget
fo
r Y
ear
1 (2
018/
19)
Targ
et
for
Yea
r 2
(201
9/20
)
Targ
et
for
Year
3
(202
0/21
)
Targ
et
for
Year
4
(202
1/22
)
Targ
et f
or
Year
5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
etRe
spon
sibi
lity
5.3.
2 En
hanc
e ca
paci
ty b
uild
ing
and
chan
ge
man
agem
ent
Cont
inua
llyIm
plem
enta
tion
m
atri
xIm
plem
enta
tion
m
atri
xIm
plem
enta
tion
m
atri
xIm
plem
enta
tion
m
atri
xIm
plem
enta
tion
m
atri
x H
-HR&
A
5.3.
3 Cr
eate
aw
aren
ess
of
and
impl
emen
t gr
ieva
nce
hand
ling
proc
edur
es
Year
1 a
nd
cont
inua
lly
Cult
ure
Asse
ssm
ent
repo
rt
Asse
ssm
ent
repo
rtAs
sess
men
t re
port
6 Mill
ion
H-H
R&A
5.3.
4 En
hanc
e cr
eati
vity
and
in
nova
tion
(i
nnov
atio
n la
bs/s
umm
its)
Annu
ally
Num
ber
of
inno
vati
on l
abs
and
sum
mit
s he
ld
24
44
450
M
illio
nDS
PM
5.4
Impl
emen
t th
e ne
w
orga
niza
tion
st
ruct
ure
5.4.
1 U
nder
take
m
appi
ng &
pl
acem
ent
of s
taff
to
the
upda
ted
stru
ctur
e.
End
of
Year
1 R
epor
tRe
port
250
Mill
ion
H-H
RA
5.4.
2 U
pdat
e th
e ca
reer
pr
ogre
ssio
n gu
idel
ines
End
of
Year
1
Upd
ated
& A
p-pr
oved
Car
eer
Gui
delin
e
Upd
ated
&
Appr
oved
Ca
reer
G
uide
line
H-H
RA
5.4.
3 In
duct
st
aff o
n th
e ne
w r
oles
&
func
tion
s.
Q1-
50%
Q2-
30%
Q3-
20%
No.
of
staff
. 10
0%H
-HRA
61 56
67
STRA
TEG
IC I
SSU
E 3:
EN
HA
NCE
IN
STIT
UTI
ON
AL
CAPA
CITY
OBJ
ECTI
VE
1: T
o en
hanc
e co
mpl
ianc
e to
goo
d co
rpor
ate
gove
rnan
ce
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
ePe
rfor
man
ce
Indi
cato
rBa
selin
e Ta
rget
fo
r Y
ear
1 (2
018/
19)
Targ
et
for
Yea
r 2
(201
9/20
)
Targ
et
for
Year
3
(202
0/21
)
Targ
et
for
Year
4
(202
1/22
)
Targ
et f
or
Year
5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
etRe
spon
sibi
lity
5.5
Mai
nstr
eam
ap
plic
atio
n of
te
chno
logy
in
serv
ice
deliv
ery
5.5.
1 In
crea
se
auto
mat
ion
of b
usin
ess
proc
esse
s
End
of Y
ear
1 an
d 2
% Au
tom
atio
n.
80%
100%
4,25
0 M
illio
nH
-ICT
5.5
2 En
hanc
e in
form
atio
n sy
stem
sec
urit
y co
ntro
l
cont
inua
llyre
port
repo
rtre
port
repo
rtre
port
repo
rt31
M
illio
nH
-ICT
57
6868
OBJ
ECTI
VE 4
: S
TAKE
HO
LDER
ALL
IAN
CES
AN
D P
ART
NER
SHIP
S
OBJ
ECTI
VE
1: T
o en
hanc
e sy
nerg
ies
in i
nfor
mat
ion
and
reso
urce
sha
ring
wit
h pa
rtne
rs a
nd s
take
hold
ers.
Out
put/
Out
com
e
Stra
tegy
Act
ivit
yTi
me
fram
e
Perf
or-
man
ce
Indi
cato
rBa
selin
e Ta
rget
for
Ye
ar 1
(2
018/
19)
Targ
et f
or
Year
2
(201
9/20
)
Targ
et f
or
Year
3
(202
0/21
)
Targ
et f
orYe
ar 4
(2
021/
22)
Targ
et f
or
Year
5
(202
2/23
)
Tota
l fo
r th
e Pl
an
Peri
od
Budg
etRe
spon
sibi
lity
6.1
Enha
nce
enga
gem
ent
and
buy-
in w
ith
stak
ehol
ders
6.1.
1 Co
ntin
uous
eng
age-
men
t w
ith
key
stak
ehol
ders
to
str
engt
hen
part
ners
hip
and
sust
aina
bilit
y
No.
of
acti
viti
es4
44
44
2015
0 M
illio
n
DOQ
ADS
PM
6.1.
2 In
crea
se s
trat
egic
pa
rtne
rshi
ps f
or s
ervi
ce
deliv
ery/
Agen
cy M
odel
No.
44
6.2
Colla
bora
te
wit
h co
mpl
emen
tary
Ag
enci
es/
Insu
ranc
e sc
hem
es t
o ex
pand
cha
nnel
s fo
r N
HIF
pro
duct
s
6.2.
1 M
ap a
ll pr
ivat
e an
d co
mm
unit
y-ba
sed
heal
th
insu
ranc
e sc
hem
es
Map
ping
re
port
Map
ping
re
port
of
all
sche
mes
20
Mill
ion
DOQ
ACS
6.2.
2 De
velo
p an
d im
ple -
men
t pa
rtne
rshi
p m
odel
s in
di
stri
buti
on o
f N
HIF
pro
duct
s (A
genc
ies)
Part
-ne
rshi
p ag
ree-
men
ts
210
2025
25
DOQ
ADS
PMH
CC
6.3
Mai
nstr
eam
Co
rpor
ate
Soci
al
Sust
aina
bilit
y (C
SS)
Init
iati
ves
Deve
lop
and
impl
emen
t a
corp
orat
e su
stai
nabi
lity
fram
ewor
k an
d pa
rtne
rshi
p m
odel
s fo
r eff
ecti
ve l
inka
ges
No.
Of
Part
ner -
ship
s1
23
44
750
Mill
ion
DSPM
62 58
http://www.nhif.or.ke
@nhifkenya
@nhifkenya
@nhifkenya
20182022
NATIONAL HOSPITAL INSURANCE FUNDP.O BOX 30443-00100,NAIROBI,KENYA
Tel: 020 273 1249/50/52/53/54/55/56 * 020-2712733 MOBILE: 0726-268933 Toll free: 0800 720601
