The Social Health Insurance bills became Acts of Parliament by a stroke of the President’s hand on October 19th, 2023. The purpose of the Acts is to improve healthcare financing directed towards the improvement of healthcare service delivery. The beauty of the Acts is that it has a mixed model of financing.
There is the insurance aspect which is contributory in nature. Regulations are currently being drafted on the same. Many proposals have been laid on the table. My individual proposal on contributions was to cap the amounts should a percentage of the pay be chosen. My second proposal on that was that the percentage calculation should be on net pay not on gross pay. This is because salaried workers tend to be victims of multiple taxations, both formal and informal. They not only get taxed at source (PAYE, housing levy, NHIF, NSSF) but they also pay for the care of others not in a tax structure (Black Tax).
A better health financing model for healthcare is the tax-funded model, which the Kenya Medical Association (KMA) has always advocated for. This is where the government uses taxes collected to fund a little of the healthcare. The conundrum of ensuring equity in contribution is solved in this way. There has always been the debate of how to bring in the 80% of Kenyans who may be in informal sector into contributing to their healthcare. There is no magic about that. The government could allocate a percentage of tax collected to healthcare. It is suggested that the emergency fund and chronic disease fund will be tax-funded. This is very welcome.
A return of the Facility Improvement Fund (FIF) to the individual health facilities will boost facility services. It was extremely unfortunate that funds generated by facilities were diverted to the county funds and used for services other than healthcare. This led to a drop in the overall collections and demotivation of staff and shortage of supplies in these facilities. The FIF Act is God-sent. But it will have resistance from several quarters. We watch that space.
A tax-funded healthcare model though must be accompanied by quality healthcare services. There must be high quality healthcare facilities complete with the necessary capabilities to deliver high quality care. The facilities must have the necessary services needed to deliver care. This means that the equipment in these facilities must be fit for service to deliver services.
More important there must be the highest qualified, well trained, motivated, and well remunerated health workforce. The Kenya Health Human Resources Advisory Council (KHRAC) has promised to resolve the problems that have faced by HRH especially over the last ten years of devolution. They have promised to facilitate worker portability, equitability of pay and other benefits such as mortgage and affordable credit for health workforce, and continued access specialist training. We wait to see if this will happen.
The elephant in the room though is the challenges faced by the National Health Insurance Fund (NHIF) and other fund managers who manage public funds for healthcare. As I write this article the NHIF has not paid a large chunk of monies owed to health facilities as far back as the year 2017. Moreover, there are many complaints about the process of preauthorization especially for surgical procedure. Some surgeons have said that delays in pre-authorizations is tantamount to mismanagement and negligence.
NHIF is not the only payer that medics are complaining about. MAKL is a fund administrator in charge of teachers and police funds. Healthcare facilities that treat many teachers and police, especially in the rural areas, have threatened to move to court to force the fund administrator to pay for services offered. They complained that lack of payment for services have lead to a scale down of services they are able to offer, non-payment of suppliers and creditors and eventually laying off staff leading to unemployment.
As the Social Health Insurance takes hold it is important that the transition ensures that all the debts of NHIF and all monies owed by other public fund administrators are paid. We must also keep watch of all those charged with management of health funds to ensure that health facilities are actually remunerated for their work on time. This should be well documented in the regulations that are being drawn up as we write.
