Consultancy to Conduct a Feasibility Study on the Introduction of a Maternity Cash Benefit into the National Hospital Insurance Fund in Kenya at International Labor Organization (ILO)

Background and Introduction

Maternity protection for women workers falls directly under the social protection mandate of the ILO and has been a core issue since its foundation in 1919. It was during the first International Labour Conference in 1919 that Maternity Protection Convention, 1919, (No.3) the first convention on this issue was adopted. This Convention was followed by two others: Convention No. 103 in 1952 and Convention No.183 in 2000 as well as Recommendation No. 191, which progressively expanded the scope and entitlements of maternity protection at work. The main concern on the protection of women workers has been, on one hand, to ensure that women’s work does not pose risks to the health of the woman and her child. On another hand, to ensure that women’s reproductive roles do not compromise their economic and employment security. While maternity protection contributes to the advancement of gender equality in the world of work, it also contributes to the empowerment of women, reduces child mortality and improves maternal health which is well aligned to Sustainable Development Goals 1, 3, 5 and 8.

Social protection floors are nationally defined sets of basic social security guarantees that secure protection aimed at preventing or alleviating poverty, vulnerability and social exclusion. They are enshrined in international social security standards. The ILO Social Protection Floors Recommendation, 2012, No. 202 assists member States in covering the unprotected, the poor and the most vulnerable, including workers in the informal economy and their families. Social protection floor guarantees should ensure at a minimum that all citizens in need must have access to essential protections necessary to survive in society during their lifetime.

The National Hospital Insurance Fund (NHIF) is commissioning a feasibility study to set up a maternity income protection benefit for all its female members. The feasibility study will have to consider a mix of financing through which NHIF members are currently enrolled and other potential options.

Consultations with stakeholders will be held to discuss the introduction of the new maternity income protection benefit to create buy-in and political endorsement from an early stage.

NHIF background

The National Hospital Insurance Fund (NHIF) was established as a State Corporation regulated by the NHIF Act of 1998. NHIF extends coverage to both ‘formal sector’ (contractually-employed) individuals and informal sector workers (voluntary members) to participate in a risk-pooling (social) insurance system, to meet the cost of treatment for its contributing members – and their immediate family members. In 2018, according to NHIF, the fund had 7 million principal members and thus covers a total of around 21 million people, roughly half of Kenya’s population (NHIF, 2019). In recent years, the NHIF has reviewed its portfolio of activities in the light of expanding its services and coverage to all workers especially those in the informal economy (with their families) and vulnerable groups. Voluntary members are required to make a contribution at a monthly rate of KES 500 while those in formal employment contribute based on a graduated scale as per their income with the least being KES150 and a maximum of KES1700. Currently, 3.6 million members from the informal sector are voluntarily insured. However, out of the 3.6 million, only 1.5 are active members, meaning that they have paid their contributions in the last 12 months.

NHIF is facing the challenges of adverse selection and low retention rates within the voluntary contributors coupled with high utilization of services. To address this, NHIF has deployed strategies such as encouraging contributors to make upfront one-year payments, effecting a waiting period of 60 days post-payment or penalty for the late contributions before voluntary members can access services. This has however exacerbated the inadequate coverage of the informal and rural economy workers.

Further, NHIF has extended coverage to poor and vulnerable households through health insurance subsidies including (a) elderly individuals over 65 years who receive benefits from the OPCT scheme; (b) the Health Insurance Subsidy Programme (HISP), which targets children classified as Orphans and Vulnerable Children (OVCs) linked with care-givers and listed as beneficiaries of the OVC-CT programme and the Linda Mama Program providing access to free maternity services to all pregnant women who are Kenyan citizens. Data on the vulnerable populations is provided by the Ministry of Labour and Social Protection (MLSP). The automatic enrolment of all recipients of the Inua Jamii Senior Citizens’ Programme and persons with disabilities in the NHIF is envisaged by the government. In some cases, counties or third parties such as UNHCR pay the contributions for specific groups, such as vulnerable refugees. Additional categories of members include Secondary students in public schools and Civil Servants and Disciplined Services.

Objectives of the study

The objective of this consultancy is to conduct a feasibility study on the introduction of a maternity cash benefit into the National Hospital Insurance Fund in Kenya.

1. Conduct a feasibility study:

a. Design of the new maternity benefit;

Support NHIF regarding the design of the maternity cash benefit for all NHIF beneficiaries and different design options and criteria that need to be considered. This includes the waiting duration for new / inactive members, the level of maternity income benefits, leave period, frequency of payment and the different options on how NHIF recovers the costs (contribution rates and other policy options). Potential impacts on the legal framework will be identified.

b. Assess the institutional capacity to deliver the new benefit;

Institutional arrangements and operational processes that might need to be adapted should also be covered in the study.**

c. Assessment of the financial impact of the introduction of the new benefit

The ILO actuarial platform ILO-HEALTH will be used to assess the financial impact of the different design options for the new benefit, with a view to inform the policy dialogue and decision on the final design and related contribution level for the new benefit. This includes a demographic and employment analysis of the population as well as specifically of the membership of NHIF. The consultant will be expected to gather relevant data to support the ILO HQ team to perform the financial impact assessment and include the results in the report. **

2. Organise a learning and dialogue forum on maternity protection:

The consultants are expected to support the organization of a two day dialogue with government representatives, workers and employers’ representatives, including those in the informal and rural economy, civil society, Council of Governors and other key stakeholders. The forum should cover relevant ILO standards on social security with an emphasis on maternity protection, the type of benefits for maternity protection, the financing of the maternity benefit, institutional and legal arrangements and international good practices of maternity protection.

Project Management

The consultant/consultancy firm will work under the supervision of the ILO. Oversight and guidance will be provided by the Technical Committee comprising project staff of ILO and NHIF which will endorse outputs and deliverables.

Expected Products / Outputs

The consultancy will be expected to deliver the following:

1. Inception report with work plan
2. Consultative stakeholder dialogue forum and Key Informant Interviews
3. Preliminary feasibility study report presenting design options for the new maternity income benefit (based on stakeholder engagement and desk review).
4. Stakeholder dialogue to validate the options of the preliminary feasibility study and design options.
5. Final consolidated and validated report (after review of NHIF and ILO).

Reports

The consultancy will prepare an Inception Report with a detailed work plan plus the proposed timeline, which shall be presented to ILO and NHIF to be cleared. Moreover, the consultancy will prepare a preliminary report and presentation of design options. This will be presented and used for the stakeholder dialogue, through which the options will be validated. The preliminary feasibility study including the costing, will be presented to ILO and NHIF. A final report will be prepared thereafter and submitted to ILO and NHIF.

Timeline

This study is planned to be carried in Q1/Q2 of 2021.

Risks and Assumptions

COVID-19 will hinder the ability of consultants to interact with both key stakeholders and the population as well as travel.

Logistics

The consultant/consulting firm will plan and organize its own logistics including travel, accommodation and meetings. However, NHIF will provide key contacts during field work. Overall the consultancy will entail design and development of methodology and tools, conducting field survey, analysis and reporting.

Required qualifications, desired competencies, technical background and experience

The consultant(s) and/or consultancy team will require the following experience and skills:

Technical expertise

• Relevant advanced academic degree (Social sciences, development studies, economics or related fields); previous experience leading teams; knowledge of social protection programs; health policies; labour markets; social security benefits and, maternity benefits.
• Demonstrated international/local experience in undertaking complex social and public policy analysis;
• Demonstrated ability for managing stakeholders and high level government representatives.
• Specific experience in undertaking complex social and economic research and providing authoritative analysis and guidance for policy makers.
• Demonstrated ability for managing stakeholders and high level government representatives.
• Ability to facilitate consultative/validation workshop towards consensus building.
• Excellent writing and communication skills in English.
• Proven ability to:
  • handle multiple tasks under pressure with short deadlines;
  • ability to work independently, seeking guidance on complex issues; and
  • excellent interpersonal skills, proven team orientation and the ability to work across unit boundaries