Abstract of Muinde’s paper:
Over the last decade, the Kenya government has continued to expand the country’s national health insurance (National Hospital Insurance Fund, NHIF) to include those in the informal sector as well as providing free maternal health care and health insurance subsidies for the vulnerable populations such as the beneficiaries of cash transfer schemes and elderly persons. Recently, the government has even resulted to coercive measures in persuading its citizens to become members or pay premiums to the NHIF. The Kenyan state portrays the national health insurance as a national collective and frames it within the language of common good, equity, financial protection and state responsibility to care. Despite the government’s commoning practices and processes in the domain of healthcare, public health facilities remain badly under-resourced and the national health insurance does not offer reliable access to healthcare. In many cases, patients and health workers navigate both mundane and persistent complexities, disappointments, frustrations and failure of the national health insurance through different solidarities: ethnic and kinship based, and patronage networks. The increasing digitization of Kenya’s economy through mobile money technology over the last decade has transformed these forms of solidarities/networks of care in different ways. Based on ethnographic fieldwork in Kenya, this paper explores alternative commoning practices in the form of solidarity and collectives that are forged, maintained and reinforced at the intersection of commoning healthcare distribution through the country’s national health insurance and the limits of the health insurance as commons (in terms of care).