{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:51:27Z","timestamp":1791521487991,"version":"4.3.4"},"reference-count":19,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Public Health Challenges"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Kenya transitioned its health financing from the National Health Insurance Fund (NHIF) to the Social Health Authority (SHA) in 2024. This model was designed to advance efficiency and equity, ultimately leading to universal health coverage (UHC). Shortly thereafter, the government introduced a parallel Enhanced Public Officers Medical Scheme Fund (POMSF), tailored to privilege public officers through dedicated funding and benefits. This article explores the implications of this targeted scheme on equity in strategic purchasing and the journey towards UHC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>The article is a policy perspective grounded on document review of legislation, regulations, government documents and grey literature. Evidence was identified through targeted searches of PubMed, Google Scholar and Kenyan sources. Analysis was guided by the Strategic Purchasing Resource Centre for Africa (SPARC) and RESYST strategic purchasing frameworks and organized across governance, revenue mobilization, risk pooling, benefit design, provider contracting, provider payment, access protocols, financial protection and accountability. Comparative evidence from civil\u2010servant and segmented insurance arrangements in Thailand, Tanzania and Indonesia was used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>SHA is designed to support population coverage, cross\u2010subsidization, standardized entitlements and primary healthcare\u2013led access. POMSF, although administered through SHA, relies on ring\u2010fenced public financing, a scheme\u2010specific governance structure, enhanced benefits, separate contractual arrangements, negotiated tariffs and flexible access pathways for public officers. These features may improve financial protection and service responsiveness for beneficiaries but risk\u2010fragmenting pools, weakening redistribution, creating unequal entitlements and generating competing provider incentives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>POMSF is not inherently incompatible with UHC, but its equity effects depend on how it is financed, governed and linked to SHA. Kenya should establish transparent financial links, common purchasing standards, harmonized tariffs and referral rules, integrated data and accountability systems, and periodic equity review. Without these safeguards, POMSF may entrench a two\u2010tier system, weaken solidarity within health financing and Kenya's movement towards equitable UHC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/puh2.70418","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:48:04Z","timestamp":1791521284000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implications of Kenya's Enhanced Public Officers Medical Scheme on Equity in Strategic Purchasing and Progress Towards Universal Health Coverage"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7137-9775","authenticated-orcid":false,"given":"David","family":"Olpengs","sequence":"first","affiliation":[{"name":"Health Systems Strengthening Directorate Amref Health Africa  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Moraa","sequence":"additional","affiliation":[{"name":"Health Economics Research Unit KEMRI\u2010Wellcome Trust  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boniface","family":"Mbuthia","sequence":"additional","affiliation":[{"name":"Health Systems Strengthening Directorate Amref Health Africa  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"The Kenya Law The Social Health Insurance Act No. 16 of 2023 Kenya Gazette Vol. CXXV No. 249(2023) https:\/\/new.kenyalaw.org\/akn\/ke\/act\/2023\/16\/eng@2023\u201011\u201024."},{"key":"e_1_2_12_3_1","unstructured":"Health Intervention and Technology Assessment Program (HITAP) National Hospital Insurance Fund (NHIF) Health Financing Reforms Experts\u2019 Panel (HEFREP) Visit to Thailand on Universal Health Coverage (UHC) and Health Technology Assessment (HTA) June 5th\u20137th 2019(2019).https:\/\/www.hitap.net\/en\/document\/nhif\u2010hefrep\u2010uhc\u2010hta\u2010visit\u2010thailand\/."},{"key":"e_1_2_12_4_1","unstructured":"The Kenya Law The Public Finance Management (Public Officers Medical Scheme Fund) Regulations Kenya Gazette Vol. CXXVI No. 230(2024) https:\/\/new.kenyalaw.org\/akn\/ke\/act\/ln\/2024\/195\/eng@2024\u201012\u201027."},{"key":"e_1_2_12_5_1","unstructured":"The Kenya Law The Social Health Insurance Regulations Legal Notice 49 of 2024. (2024) https:\/\/new.kenyalaw.org\/akn\/ke\/act\/ln\/2024\/49\/eng@2024\u201003\u201008."},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0195179"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czu120"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czy091"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(18)31647\u20107"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/23288604.2015.1020642"},{"key":"e_1_2_12_11_1","unstructured":"RESYST What is Strategic Purchasing for Health? [Internet](RESYST 2014) https:\/\/resyst.lshtm.ac.uk\/sites\/resyst\/files\/content\/attachments\/2018\u201008\u201022\/What%20is%20strategic%20purchasing%20for%20health.pdf."},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/23288604.2022.2051796"},{"key":"e_1_2_12_13_1","unstructured":"Ministry of Health Kenya Tariffs To The Benefit Package Under The Social Health Insurance Act No. 16 of 2023 (2023) https:\/\/health.go.ke\/sites\/default\/files\/2024\u201011\/TARIFFS%20TO%20THE%20BENEFIT%20PACKAGE%20TO%20THE%20SHI.pdf."},{"key":"e_1_2_12_14_1","volume-title":"Government Signs POMSF Contracts, Launches SHA Biometric Registration for Dependents","author":"Ministry of Health","year":"2026"},{"key":"e_1_2_12_15_1","unstructured":"The Social Health Authority Framework Agreement for the Provision of Emergency Air Evacuation Services for Beneficiaries of the Public Officers Medical Scheme Fund for a Period of Three (3) Years (2026)https:\/\/tenders.go.ke\/storage\/Documents\/1772531728597\u2010tender\u2010document.pdf."},{"key":"e_1_2_12_16_1","volume-title":"CS Duale Chairs Signing of Joint Communiqu\u00e9 to Streamline POMSF Service Delivery","author":"Ministry of Health","year":"2026"},{"key":"e_1_2_12_17_1","unstructured":"Ministry of Health Kenya Health Facility Census Report 2023(Ministry of Health 2023) https:\/\/www.health.go.ke\/sites\/default\/files\/2024\u201001\/Kenya%20Health%20Facility%20Census%20Report%20September%202023.pdf."},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12939\u2010019\u20101088\u2010x"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.19.234153"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czab003"}],"container-title":["Public Health Challenges"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/puh2.70418","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/puh2.70418","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/puh2.70418","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:48:09Z","timestamp":1791521289000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/puh2.70418"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,8]]},"references-count":19,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["10.1002\/puh2.70418"],"URL":"https:\/\/doi.org\/10.1002\/puh2.70418","archive":["Portico"],"relation":{},"ISSN":["2769-2450","2769-2450"],"issn-type":[{"value":"2769-2450","type":"print"},{"value":"2769-2450","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,8]]},"assertion":[{"value":"2026-01-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70418"}}