The National Hospital Insurance Fund (NHIF) plays a pivotal role in providing health insurance to Kenyans. The mandate of NHIF is expanded to include health subsidy programmes that cover poor and vulnerable households that cannot afford health care. Linda Mama is a health subsidy programme targeting Kenyan mothers and covers ante-natal, delivery and post-natal services. Under this programme, mothers are covered for; pregnancy care, delivery in a health facility, postdelivery care, and outpatient baby care offered at Level 2. NHIF works with accredited health facilities which are either public, private or faithbased.
Machakos county has a population of 1.4 million people, making it the ninth most populated county according to the Population and Housing Census by the Kenya National Bureau of Statistics (KNBS). About 23 per cent of households in Machakos live in poverty, according to KNBS. This means that approximately 93,000 of Machako’s 402,000 households are poor. The county has 187 public health facilities, of which 96 percent are dispensaries and health centres.1 Health insurance coverage in the county stands at 19 percent, with deliveries in health facilities at 92 percent. These indicators provide the picture of a county doing well in some respects, such as maternal health but also challenges in other areas such as health insurance and poverty. NHIF’s schemes across the county aim to ensure wider coverage of health insurance and cushion poor households from the negative impact of health costs. This study focuses on the information available on NHIF in Machakos county as presented in the county’s budget documents and through interviews with key health, finance, and legislators. The study focused on the Linda Mama Scheme in the county as one of the key programmes of NHIF.