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