Elizabeth Njeri Kamau, Dr. Caroline Kimutai


Since the devolution of the health sector to the counties, performance in public health hospitals in Kenya has been an issue of concern in terms of inefficiencies resulting to poor service delivery and lack of quality of care in the hospitals. Despite the high coverage of NHIF, financial performance in public hospitals in Kenya has been an issue of concern. The overall goal of this research is to look at the impact of healthcare schemes on public hospital financial performance in Nairobi City County. The specific objectives were to establish the effect of Civil Servants scheme, HISP scheme, Linda Mama scheme and National scheme on the financial performance of public hospitals in Nairobi City County. The descriptive design was applied in this study. The population of interest comprised of the 80 public hospitals in Nairobi City County where the census technique was used. The study covered a period of 2 years that included the year 2019 and 2020. The secondary data was collected through a data collection sheet. The study carried out descriptive statistics and inferential analysis such as Pearson correlation and multiple regression model was used to assess the collective effect of four independent variables on the dependent variable. The study used Statistical Package for Social Science (SPSS) as a data analysis tool. It was concluded that Civil Servants scheme, Health Insurance Subsidy programme, Linda Mama scheme and National scheme had a positive and strong effect on the financial performance of public hospitals in Nairobi City County in terms of operating surplus/deficit. It was recommended that NHIF put in place good financial management practices to enhance the accountability of the funds directed to the Civil Servants Scheme. NHIF should increase the level of funding through the Health Insurance Subsidy scheme as the scheme target the near poor people who may not afford health insurance. NHIF should sensitize more women to join the Linda Mama scheme so that they get prenatal and antenatal care through proper delivery in hospitals. NHIF should sensitize the public and especially those in the informal sector who are not covered by the National scheme on the importance of coverage while at the same time enhancing the accountability of the funds contributed.

Keywords: Civil Servants Scheme, HISP Scheme, Linda Mama Scheme, National Scheme, Financial Performance

Full Text:



Abiiro, G. A., & McIntyre, D. (2013). Universal financial protection through National Health Insurance: a stakeholder analysis of the proposed one-time premium payment policy in Ghana. Health policy and planning, 28(3), 263-278.

Agarwal, R., Mazurenko, O., & Menachemi, N. (2017). High-deductible health plans reduce health care cost and utilization, including use of needed preventive services. Health Affairs, 36(10), 1762-1768.

Allsop, J. (2018). Health policy and the NHS: towards 2000. Routledge.

Barasa, E., Rogo, K., Mwaura, N., & Chuma, J. (2018). Kenya National Hospital Insurance Fund Reforms: implications and lessons for universal health coverage. Health Systems & Reform, 4(4), 346-361.

Chapman, A. R. (2016). Assessing the universal health coverage target in the Sustainable Development Goals from a human rights perspective. BMC international health and human rights, 16(1), 33.

Chemouni, B. (2018). The political path to universal health coverage: Power, ideas and community-based health insurance in Rwanda. World Development, 106, 87-98.

Daniels, M., & Mbuthia, B. (2018). Implementing Linda Mama in Bungoma County Lessons on the path to universal health care. A case study developed by Gabrielle Appleford, Health System.

Etuaful, M. E. (2016). Moral hazard and healthcare utilization: a case study of insured malaria out-patients at Adansi North District, Ashanti Region, Ghana (Doctoral dissertation).

Fang, H., Keane, M. P., & Silverman, D. (2008). Sources of advantageous selection: Evidence from the Medigap insurance market. Journal of political Economy, 116(2), 303-350.

Gorsky, M., & Millward, G. (2018). Resource allocation for equity in the British National Health Service, 1948–89: an advocacy coalition analysis of the RAWP. Journal of health politics, policy and law, 43(1), 69-108.

Guest, J. F., Ayoub, N., & Vowden, P. (2017). Health economic burden that different wound types impose on the UK's National Health Service. International wound journal, 14(2), 322-330.

Hogan, D. R., Stevens, G. A., Hosseinpoor, A. R., & Boerma, T. (2018). Monitoring universal health coverage within the Sustainable Development Goals: development and baseline data for an index of essential health services. The Lancet Global Health, 6(2), e152-e168.

Hult, G. T. M., Hurley, R. F. & Knight, G. A. (2014). Innovativeness: Its antecedents and impact on business performance. Industrial marketing management, 33 (5), 429-438.

Karanja, E. (2016). Service quality and organizational performance in the health sector: a case of Mama Lucy Hospital, Nairobi. Unpublished Project University of Nairobi.

Karanja, J. W. (2014). Challenges in provision of universal health care by the National Hospital Insurance Fund, Kenya (Doctoral dissertation, University of Nairobi).

Kothari, C. R (2014). Research methodology: Methods and techniques, (2nd Ed). New Delhi, New Age International.

Kullberg, L., Blomqvist, P., & Winblad, U. (2019). Health insurance for the healthy? Voluntary health insurance in Sweden. Health Policy, 123(8), 737-746.

Lee, B., Tarimo, K., & Dutta, A. (2018). Tanzania’s Improved Community Health Fund: An Analysis of Scale-up Plans and Design. Washington, DC: Palladium, Health Policy Plus.

Mama Lucy Kibaki Hospital (2020). Retrieved from

McGuire, T. G., & Van Kleef, R. C. (2018). Regulated competition in health insurance markets: Paradigms and ongoing issues. In Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets (pp. 3-20). Academic Press.

Munge, K., Mulupi, S., Barasa, E., & Chuma, J. (2019). A critical analysis of purchasing arrangements in Kenya: the case of micro health insurance. BMC health services research, 19(1), 45.

Mutungi, B. W. (2018). Perceived Factors Influencing Uptake of Linda Mama Maternal Healthcare Delivery Programme Among Women in Informal Settlements in Starehe Sub County, Kenya (Doctoral dissertation, University of Nairobi).

Nairobi County Assembly Committee Report (2018). Retrieved from

National Hospital Insurance Fund, (2017). Strategic Transformation Towards Universal Health Coverage in Kenya Report.

National Hospital Insurance Fund, (2020). Strategic Transformation Towards Universal Health Coverage in Kenya Report.

Nguru, C. N., Kodhiambo, M. O., & Yitambe, A. (2018). Uptake of Health Insurance among Patients Attending Public and Private Hospitals in Embu County, Kenya (Doctoral dissertation, Doctoral dissertation, Kenyatta University).

Nguyen, T. (2015). The impact of the health insurance program on the near-poor in Vietnam (Doctoral dissertation, Queensland University of Technology).

Nyman, J. A. (2001). The theory of the demand for health insurance (No. 311). Discussion Paper.

Nyman, J. A. (2003). The theory of demand for health insurance. Stanford University Press.

Oladimeji, O., Alabi, A., & Adeniyi, O. V. (2017). Awareness, Knowledge and Perception of the National Health Insurance Scheme Among Health Professionals in Mthatha General Hospital, Eastern Cape, South Africa. The Open Public Health Journal, 10(1), 26-51.

Onoka, C. A., Hanson, K., & Hanefeld, J. (2015). Towards universal coverage: a policy analysis of the development of the National Health Insurance Scheme in Nigeria. Health policy and planning, 30(9), 1105-1117.

Pareto, V., & Schwier, A. S. (1971). Manual of political economy (pp. 451-2). A. N. Page (Ed.). London: Macmillan.

Proper, K. I., & van Oostrom, S. H. (2019). The effectiveness of workplace health promotion interventions on physical and mental health outcomes–a systematic review of reviews. Scandinavian journal of work, environment & health, 45(6), 546-559.

Rice, D. P., Hodgson, T. A., & Kopstein, A. N. (2015). The economic costs of illness: a replication and update. Health care financing review, 7(1), 61.

Schultz, W. J. (2001). The moral conditions of economic efficiency. Cambridge University Press.

Sepehri, A., & Vu, P. H. (2019). Severe injuries and household catastrophic health expenditure in Vietnam: findings from the Household Living Standard Survey 2014. Public health, 174, 145-153.

Singh, G. K., Daus, G. P., Allender, M., Ramey, C. T., & Vedamuthu, I. P. (2017). Social determinants of health in the United States: addressing major health inequality trends for the nation, 1935-2016. International Journal of MCH and AIDS, 6(2), 139.

Tarricone, R. (2016). Cost-of-illness analysis: what room in health economics? Health policy, 77(1), 51-63.

Thornhill, A., Saunders, M., & Lewis, P. (2012). Research methods for business students. Essex: Pearson Education Ltd.

Uche, C. (2016). Attaining universal health coverage in Nigeria using the National Health Insurance Scheme. 52nd International Course in Health Development/ Master of Public Health (ICHD/ MPH) September 21, 2015 – September 9, 2016.

Universal Health Coverage (2018). Universal Health Coverage: Moving Towards Better Health Action Framework for the Western Pacific Region.

World Bank Report (2020). Achieving Universal Health Coverage (UHC). Retrieved from

World Health Organization Report (2021). Health financing. Retrieved from

Yeshiwas, S., Kiflie, M., Zeleke, A. A., & Kebede, M. (2018). Civil servants' demand for social health insurance in Northwest Ethiopia. Archives of Public Health, 76(1), 48.

Zerbe, R. O. (2002). Economic efficiency in law and economics. Edward Elgar Publishing.


  • There are currently no refbacks.