The government has proposed a radical health plan that is to rope in every Kenyan, including newborns being registered in a universal insurance scheme.
The Social Insurance Health Fund (SHIF) in place of the current National Health Insurance Fund (NHIF) will be like a national identity card, only more powerful with proof of registration being the key that opens doors to health care and other services provided by county and national governments.
The proposal is contained in the draft Social Health Insurance Bill, 2023, and which was approved by the Cabinet on Thursday this week for tabling in the National Assembly.
“Every Kenyan shall be registered as a member of this fund. Any person who is registerable as a member under this Act shall produce proof of registration with the Social Health Insurance Fund as a precondition of dealing with or accessing services from the national government, county government or national or county government entities,” the bill reads.
Non-members are, however, never denied government services.
The requirement in the SHIF proposal mirrors the tough conditions placed by the Interior Ministry during President Uhuru Kenyatta’s administration where it made it mandatory to have Huduma Namba in order to access government services.
Then-Interior Cabinet Secretary Fred Matiang’i and many other top government officials insisted that the number was to be a must-show for Kenyans seeking services from state agencies, including acquisition of a passport, driving licence, mobile phone number and registering as a voter.
The hyped project, however, failed spectacularly despite guzzling billions of shillings, prompting protests from many quarters. Its promoters have gone silent.
In the proposed legislation under President William Ruto, it will be mandatory for a Kenyan to register as an SHIF member.
The proposed laws – the Primary Health Care Bill, 2023, Digital Health Bill, 2023 and Facility Improvement Financing Bill, 2023 – will be introduced in the National Assembly for the first reading when the House resumes sittings on September 26.
The Cabinet repealed the NHIF and replaced it with the three funds, a decision that is aimed at accelerating universal health coverage.
In the proposal that seeks to add more financial burden to Kenyans, salaried employees will be deducted up to 2.75 per cent of gross pay that will go to the new SHIF.
Kenyans’ payslips have already been thinned by the new housing tax and the increased deductions to the National Social Security Fund (NSSF).
“Children born after the commencement of this Act shall be registered at birth as members of the SHIF,” the bill says.
“A person shall pay outstanding contributions and penalties accrued before resuming access to the health care services provided.”
Anyone who fails to pay any contribution on or before the day on which payment is due shall be liable to a penalty equal to 10 per cent of the amount due for contribution for the period in which the contribution remains unpaid and the total annual contributions.
Also contained in President Ruto’s transformation of the NHIF is the Primary Health Care Bill, 2023, which essentially seeks to bring basic medical services at your doorstep by having health promoters assigned every household.
The bill provides for the formation of Community Health Units with 1,000 households to be established by every devolved government.
“A Community Health Unit shall under the coordination of a Community Health Committee be linked to a primary health care facility to facilitate access to primary care services,” the bill continues.
According to the bill, every county government will facilitate primary health care services by adopting supportive and innovative modern approaches for disease identification, monitoring, surveillance, early warning research, community education and the sharing of information.
“A community health officer shall assign to every community health promoter households in localities in such a manner as will be prescribed by the county for the purpose of facilitating access to and ensuring the effective community health services,” the bill reads.
According to the proposed legislation, the community health promoter shall among other functions, enrol and monitor the medical status of members of the families assigned.
The health promoter will also monitor the growth of children under the age of five in an assigned household and collect information on the medical status of the families.
The health promoter, according to the bill, shall provide appropriate advice in a language that the members of the household understand.
According to the proposals, devolved governments will ensure community health promoters are adequately supported through training, provision of working tools, stipends and supervision.
The bill creates the Primary Health Care Fund, which will be appropriated by the National Assembly out of the Consolidated Fund.
It is, however, a win for public hospitals as the Facilities Improvement Financing Bill, 2023 – if passed – would allow them to retain and spend the money generated at source.
According to the guidelines provided in the bill, the retained funds shall be used to sustain daily operations and promote improved health services and support optimal operations of the hospitals in order to ensure effectiveness throughout the financial year.
“There shall be retention of all the money raised or received by or on behalf of public health facilities,” the bill says.
Also contained in the NHIF transformation journey is the Digital Health Bill, 2023, which seeks to enhance access to health care through the use of technology, including for continuity of care, emergency and disaster preparedness and disease surveillance.
It will be against the law to share personal information of a patient outside the country without authority from the Minister of Health.
“The Cabinet Secretary shall take necessary measures to safeguard the transfer of a client’s medical records to and from facilities outside Kenya,” it says.
“Personal health information may only be shared to a person outside Kenya for the purposes of health tourism.”
According to the bill, the minister will be responsible for the confidentiality, privacy and security of sensitive data.
According to the bill, an individual who breaches the confidentiality in accessing the data of a patient without consent will be liable on conviction to a fine not exceeding Sh500,000 or imprisonment for a term not exceeding 15 years or both.
Through this bill, the government seeks to ensure equitable access to quality health care using ICT.
During the 2022 presidential election campaigns, Dr Ruto promised to deliver universal health coverage.
