In an effort to address the crises of health care financing, the Kenya Government has proposed the National Social Health Insurance Fund, where no payments are to be made by users at the point of being attended when ill but users will have to make regular prescribed mandatory contributions based on their incomes. However, it is unclear if these proposals are owned and have support of all key stakeholders since smooth implementation heavily depends on their participation at formulation hence their awareness, understanding and acceptance for implementation. The objective of the study, on which this paper is based, was to determine the level of participation of Kenyans in the formulation of the Social Health Insurance scheme. This study was a crosssectional descriptive survey carried out in a sample of health facilities in the North RiftValley region and at the Ministry of Health and National Hospital Insurance Fund headquarters. The respondents included patients/their visitors/caretakers (218), health facility staff(72), provincial administrators (15) and key informants (10). Data were collected using structured interview schedules and questionnaires with open and closed-ended questions. Purposive and stratified sampling methods were used to arrive at the facilities to be studied and a select key informants, systematic sampling helped arrive at the wards to be included at the national hospital, visitors interviewed at the gates were consecutively sampled while simple random sampling was used to get the patients to be interviewed at the wards; giving a total of 313 respondents. Data collected was analyzed by use of frequencies, percentages, graphical comparisons and inferential statistics of one sample student's t-test for proportions. The findings revealed poor participation levels of below twenty percent (20%) of all categories of respondents. The formulation of this policy has had insufficient stakeholder participation among all respondents. It is recommended that the Ministry of Health should make deliberate efforts to enlist the participation of all stakeholders in formulation of the National Social Health Insurance Fund. The study informs further research on participation of the public in formulation of other public policies as it has been argued that absence of this has led to failure to have support from the public who are uninvolved at formulation. For other readers, this would serve as useful information in informing them as to the importance of stakeholder participation in formulation of any plans in which these stakeholders have a key role to play.
Keywords: public participation, social health insurance policy formulation, north, rift, Kenya
It has been noted that within populations of the same country there are significant differences in health outcomes and morbidity status that are linked to socio-economic inequalities (Bobak et al., as cited in Kutzin, 2003). This is worse when viewed on a continental level. And this problem is unfortunately very prevalent: a survey done in 1987 by the World Bank in 33 sub-Saharan African countries has shown that only seven have health insurance systems, with coverage of the total population ranging from 0.001% in Ethiopia to 11.4% in Kenya (where only civil servants and a few other formal sector employees enjoy this benefit). The rest are excluded. Unfortunately, the excluded command little political support/clout (Dror & Jacquier, 2005).
The foregoing calls for full involvement and inclusion of people's views in whatever decisions are made concerning them. Yet, in most African countries, policy-making is the work of technocrats, who design policies not necessarily to benefit the wider society, but rather to ensure their continuity in power (Oyugi & Kibua, 2004). The policy-making process is cyclical and largely iterative. Its cyclical nature implies that the first phase of the cycle is subject to change as more information is realized concerning problem definition. …