Nairobi has made several reforms in recent years intended to expand health service coverage to a wider population, and with a specific focus on the poor, and to reduce financial hardship due to healthcare costs. The first of these reforms, in 2013, was the abolition of user fees at public primary healthcare facilities. The second, announced the same year, made maternity services free at all public facilities. This was upgraded in 2017 to a public funded health scheme for pregnant women and infants managed by the National Hospital Insurance Fund. Third was the introduction of a health insurance subsidy for the poor in 2014. Under this programme, the government fully subsidises the National Hospital Insurance Fund premiums for selected poor households with orphans and vulnerable children, elderly people, and people with severe disabilities. This enables access to outpatient and inpatient care at participating public, private for profit, and faith-based health facilities. The evidence from low- and middle-income countries shows that the rich rather than the poor tend to benefit more from public spending on health. Kenya is no exception in spite of health financing reforms that target the poor.

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