3.1 NHIF Members’ Level of Awareness of and Experiences with the outpatient facility selection and change process
Overall, NHIF members had a good understanding of outpatient facility selection/change and the process involved, however, there were notable variations in the level of awareness for members from rural versus urban areas. For instance, while all NHIF members from urban areas were aware of the requirement to select outpatient facilities prior to receiving services, NHIF members from rural areas struggled to describe the process of outpatient facility selection and were largely not aware of the requirement to choose a facility prior to accessing services.
Further, NHIF members from urban areas were also very conversant with the mode of changing facilities compared to their counterparts engaged in rural settings. The awareness about the selection and change of facility process was largely factored by the availability of NHIF branch offices closer to members from urban areas which enabled them to access information compared to respondents in rural settings.
I have been made aware that it is important to choose an outpatient facility where I can be treated without being admitted… you are told to choose a hospital where you can get to fast in case there is an emergency. If there is a hospital which is near you and is offering NHIF services and maybe you do not like it, you will just have to choose it.” FGD 4 Nyeri County - Urban “I did not choose, but I just used it [accessed NHIF services], I became ill and I had to go to a nearby hospital, So, when I went there, they chose for me themselves”. FGD 3 Makueni County – Rural
With regards to awareness about the approaches used to select an outpatient provider, respondents indicated that several methods are used to select or change a facility. First, respondents indicated that an NHIF member can visit the NHIF branch to choose a facility. Second, NHIF members also indicated that they could use the ‘My NHIF’application or website to select or change a facility of their choice. Lastly, the respondents also indicated the use of the Unstructured Supplementary Service Data (USSD) code ‘*155#’ on their mobile phones to choose or change a facility. Generally, respondents highlighted the ease of using the mobile-based approaches to selecting a facility and the fact that one does not require to visit the NHIF branch office to choose or change a facility.
Selection was easy because the process has been made easier, through this application. It is not the era whereby you have to move to the NHIF offices and start queuing and maybe follow up with a long queue, but now it is easy because it’s just a click of a button. If it’s an application you just click, if it’s *155# It’s very easy so the selection is not an issue.” FGD 1 Makueni County - Urban. “There was a time I chose private but you know these days there is that plan of changing after three months and you choose what you need, so I have changed and chosen the Government” FGD 2 Makueni County – Rural
However, respondents also highlighted the restriction of choice given the number and facility levels that were contracted by NHIF to provide outpatient services. It was pointed out that, most of the lower-level facilities which were closer to the respondents were not within the list of contracted facilities and therefore NHIF members had to choose contracted facilities that were often far.
On the other hand, some respondents highlighted that, although they chose a facility, they did not like the services provided but due to the extra costs to be incurred travelling to an alternative facility, they had to remain at that facility as it was closer.
I was told that I can’t select a dispensary because a dispensary cannot take NHIF. There are hospitals which you are given to choose from which have NHIF” FGD 3 Nyeri County - Rural “For outpatient, maybe you are facing a challenge with the fare on and off, going and coming back, you will be forced to choose a hospital in Emali since it is the one closest to your home and maybe you are not satisfied with the services.” FGD 4 Makueni County - Rural
Although some participants in rural areas were aware of this process, a majority were surprised that such easier platforms existed and could be used to select or change facilities. This group that was not aware, however, had either not selected a facility or had their facilities selected when the facility selection process was done at facilities themselves rather than via online or USSD code approach.
The key challenge highlighted was overall the fact that airtime was required for one to use the *155# approach and data bundles are required to use the App. Respondents would prefer the USSD code approach to be free of charge.
“I did not choose because I did not know about that * 155 # but I just wanted to get to the nearest facility to receive treatment” FGD 3 Makueni county – Rural