Framing Universal Health Coverage in Kenya: An Interpretive Analysis of Health Financing Politics

Koon, AD; (2017) Framing Universal Health Coverage in Kenya: An Interpretive Analysis of Health Financing Politics. PhD thesis, London School of Hygiene & Tropical Medicine. DOI:

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Universal Health Coverage (UHC), comprehensive access to affordable and quality health services, is a key component of the newly adopted 2015 Sustainable Development Goals (SDGs). Prior to formally adopting the goals at the United Nations in September 2015, several countries began incorporating elements of UHC into the domestic policy arena. Little research has been conducted on the process through which UHC financing policies have been contested in the political realm. In 2013, President Uhuru Kenyatta of Kenya announced initiatives aimed at moving the country towards UHC, which have proven controversial. This study drew on recent theoretical innovations in the field of critical policy studies to examine the ways in which actors understood and engaged with three highly contested health financing polices introduced as part of the movement towards UHC in Kenya: user fee removal, raising contributions to the mandatory health insurer, and the failed 2004 Bill on Social Health Insurance. In addition to document review, this study involved interpretive analysis of transcripts from 50 semi-structured interviews with leading actors involved in the health financing policy process in Kenya. The frame-critical analysis focused on how actors 1) make sense of the policy environment and create meaning through circulating finance ideas; 2) name various elements of the policy design through a process of selecting and categorizing; 3) tell stories and create narratives in ways that illustrate salient features of the process and generate shared understandings. Furthermore, this analysis also focused on what is subject to framing in this dynamic process, including 1) the substantive issues of the policies in question; 2) actor identities and relationships; and 3) the policy process itself. This study found that user fee removal was framed by finance experts as an achievable shortterm target for the Jubilee Coalition’s party manifesto. The rate increase for the mandatory insurer, the National Hospital Insurance Fund (NHIF), was consistently obscured by framing the debate around the shortcomings of NHIF and its damaged legacy. Lastly, the failed 2004 Bill on National Social Health Insurance has since fragmented into several incremental policy proposals that remain the subject of divisive framing contests. This study provides timely insight into the political dynamics surrounding the UHC movement, the policy process for health financing in Kenya, as well as theoretical and methodological considerations for frame-critical policy analysis and the field of critical policy studies more widely.

Item Type: Thesis
Thesis Type: Doctoral
Thesis Name: PhD
Contributors: Mayhew, SH (Thesis advisor); Hawkins, B (Thesis advisor);
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
Research Centre: Anthropology, Politics and Policy Group (APPG)
Funders: LSHTM Research Degree Travelling Scholarship
Copyright Holders: Adam Dale Koon


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