Health insurance as a marker of class in Kenya

In his influential work, the Sociologist Goran Esping-Andersen (1990: 23 ff) argued that social welfare itself produces a system of social stratification. He thereby contradicts the assumption that a welfare state is per se interested in producing equality among citizens with rights to social welfare. Poor-relief, which often stigmatized those receiving social assistance, was as much driven by class politics, as the social insurance model was. The latter demarcated a division between wage-earners with entitlements and those without formal employment. In short, access to social protection is intrinsically linked to class politics, and, as I argue, can even be considered as marker of class.

We can see that in Kenya’s health coverage. The National Hospital Insurance Fund (NHIF) covers mainly the urban, formally employed population and so does the private health insurance sector. In total, 6.3 Mio. Kenyans were principal members with NHIF in 2016 (Ng’ethe 2016) and premiums are deducted from the salary. The unemployed can opt for a membership at KES 500 per month, a sum that most informally employed are not able to afford consistently with their irregular and unpredictable incomes. “Earlier NHIF (…) focused to support the poor, but the new NHIF supports those with income (…) the employed support the unemployed, (but) if you don't pay, you cannot be assisted”, tells me the Branch manager of NHIF (Int. 2016).

In Kenya, I argue, the middle class has access to NHIF and also to private health cards, however, it still needs to set money aside for un- or underemployed relatives who have limited access to institutionalized forms of protection.