The latest move from NHIF Kenya to Social Health Authority had 3 weak points
1. Failure to cap SHIF deductions.
2. Removing the civil service scheme
3. Forcing private insurances on public officers.
Let’s look at those three and propose a way forward.
1. Failure to cap SHIF deductions.
2.75% deduction of gross incomes (or perceived incomes) will be made to all of you. Even those who think that they have been spared because they are not formally employed, trust you me the government via SHA, will assign you an income that will ensure you pay more than the KES 300 peddled as the amount majority will pay. I consider this partial propaganda. After deducting 2.75% of gross income (or projected income) the government should be offering comprehensive health services. But the proposed benefits do not match these deductions.
As Wandia Njoya has opined, the use of the word ‘Social’ before Health, is to push capitalistic motives hidden in the word. So the government uses a skewed concept of ‘equity’ to rip off those they baptize as ‘high earners’ to pay for what the government should have paid for via tax-funded model, then the government takes credit for healthcare.
2. Removing the civil service health scheme
Removal of the management of the civil servants scheme by NHIF / SHA, claiming that it was ‘eating into the so called national schemes’, is a clever way of privatizing medical insurance of public sector. Indeed the civil servants had a scheme ‘under NHIF’. This is because their employer (government) CHOSE to transfer the medical cover money to NHIF (government/public) to run a medical scheme. The services were indeed good. What then SHA should have done was to improve the national scheme clients to who were purpotedly not enjoying ‘good healthcare’ of the Civil Servants and bring them up to speed, by topping up for them. After all health is a social good and a responsibility of a responsible government. Instead the government chose to ‘downgrade’ everyone to perceived poor healthcare and leave civil servants without a medical cover as well as all the other schemes such as retired civil servants.
Who downgrades the quality of healthcare for its citizens?
3. Forcing private insurances on public officers.
After deleting the civil servants health scheme (and all other schemes like KARRO) SHA has asked national and county governments to procure private medical cover for its employees. Surely which government does that? Even GOK vehicles do not have private licences. Why? The government is the ultimate licensor.
We all know what private medical covers have done to the public sector since being sneaked in in 2010. From time immemorial we have maintained that government is to provide cover for public sector. Over the last 14 years there is no comparison in terms of quality between healthcare of PUBLIC servants covered by NHIF (as protected by Unions) and those covered by other private insurances especially procured by County governments & commissions.
In summary
NHIF had it’s inherent issues that needed to be sorted out. These were well outlined in a review of NHIF, a review that even Kenya Medical Association participated in.
But to move forward, the government must accept that it is not all knowing. The people have a say.
And to avoid throwing the baby away with the birth water a few tweeks to the healthcare policy will do:
1. Cap contributions to SHIF to KES 5,000.
2. Return the PUBLIC Civil Servants Scheme and stop forcing private insurances for public personnel.
3. Bring the health benefits to Wanjiku up to standard with the Civil Servants Scheme
4. Improve the buying power of Kenyans by avoiding overtaxation, capping the Central Bank of Kenya Rates so that banks do not run amok with interests rates effectively reversing all the economic gains we made in 2 decades.
At the end of the day a tax-funded UHC has always been our call.
Dr Simon Kigondu is an obstetrician gynaecologist and a commentator on health matters