Case study Household 3: Under coverage

Cleophas is a farmer and his wife (56 years old) have four children-one in college and three children of high school going age. They also take care of three orphans aged 12, 10, and 7 years. He has NHIF and his wife and biological children are all included in his cover. Cleophas has had two hernia operations costing Kshs. 100,000(US$830) and Kshs. 81,000 (US$675) each. Both times, he fundraised for the hospital bills through friends, family and well-wishers. He also sold some cows to raise additional funds. It is then that he decided to enroll for NHIF because a provider advised him to get insurance to avoid incurring more high medical bills for future treatment. Recently, one of his daughters fell sick while in boarding school away from home and he had to send Ksh. 5,000(US$41) for her treatment even though she is covered under his NHIF plan. The outpatient facility she is registered under is closer to home but farther from her school and so they had no choice but to pay cash. Although she should have been covered under the Edu-Afya program that provides health insurance to all secondary students, she had not been registered through the school at the time. In the past, the family has used chama (community financial groups) loans to pay for healthcare. Despite having NHIF, Cleophas reports paying for many test and scans. He complains about the high cost of premiums but continues to pay because he needs to access treatment and procedures that are otherwise too costly but wishes the challenges with the cover would be addressed so he can be fully covered. (IDI_A_Active_02)