Members of the National Assembly are this morning scheduled to debate proposed amendments to the health laws that would see a major transformation of healthcare in the country.

The amendments to the National Hospital Insurance Fund (NHIF) Act and Health Act will not only see the introduction of a mandatory universal healthcare for all Kenyans above the age of 18, but will also see the Fund cutting down on some costs.

National Hospital Insurance Fund (Amendment) Bill, 2021, that comes for the Third Reading in Parliament, seeks to establish a scheme to be known as the Universal Health Coverage Scheme that will make it mandatory for every adult Kenyan to contribute a minimum fee as the government prepares health cover for all.

The planned mandatory NHIF membership for all Kenyans will be an upgrade of the current scheme where only workers in the formal sector are compelled to join.

Should the proposed amendments sail through, each adult Kenyan will be required to part with Sh6,000 annually to be enrolled in the universal health scheme for outpatient and inpatient services, including maternity, surgery and treatment of chronic diseases.

To make the amendments functional, NHIF has suggested a number of rules, among them putting a cap on the treatment for chronic ailments like dialysis, cancer, heart and liver failure, among others.

On dialysis, NHIF intends to cut the current rate of Sh9,500 to Sh6,000 a week to reduce the budget by Sh1 billion to about Sh2.7 billion annually.

Apparently, NHIF members are entitled to two weekly sessions of dialysis, translating to Sh960,000 per patient each year.

Also scheduled to suffer a setback are patients undergoing chemotherapy and radiography as well as those earmarked for surgeries.

The Fund is also scheduled to raise the waiting period before one is expected to start getting benefits from the current three months to at least six months.

NHIF Chief Executive Peter Kamunyo, while expressing surprise that the draft proposals had landed in the hands of the media, said they are still at preliminary stage.

 “Those are draft proposals that we are still going through with our experts. We are yet to approve them,” he  said as he promised to issue a detailed statement.

But contrary to earlier fears from trade unions and employers, the two schemes, NHIF and UHC will be operated independently but under one oversight body.

“The Universal Health Coverage Scheme shall be administered by the Board separately from the other schemes administered by the Fund,” states part of the proposed bill.

Access to quality healthcare

The purpose of the Universal Health Coverage Scheme shall be to facilitate access to quality, promotive, preventive, curative, rehabilitative, and palliative health services based on need, social and financial risk protection.

The Bill seeks to amend NHIF Act No. 9 of 1998, disband, in total, to rename it as National Health Scheme.

Central Organisation of Trade Unions (Cotu) and the Federation of Kenya Employers (FKE) have opposed the bill and have asked MPs to shelve it to allow further consultations. 

Yesterday, Cotu Secretary General Francis Atwoli said they welcomed the proposals with a lot of scepticism because of NHIF’s lack of capacity, infrastructure and rampant corruption.

Atwoli was, however, full of praise for the last-minute decision to have NHIF and UHC operate separately.

“But we are opposed to some of the proposals that would mandate the  Health minister to nominate one person nominated by the umbrella body representing the trade unions because it is ambiguous.

This section is likely to be misused by the minister in the event he falls out with Cotu,” he said. 

President Uhuru Kenyatta has been at the forefront in appealing to MPs to pass the Bill, saying it will offer his administration a chance to provide affordable healthcare for all Kenyans.

Last evening, Deputy President William Ruto hailed the proposals as “a great milestone and long overdue”.

On his twitter handle, Ruto said: “The NHIF Bill is four years behind schedule, delaying the roll out of UHC.

Tomorrow is the single most important day in the life of the 12th Parliament as Kenyans await the passage of the Bill so that millions of struggling families can have access to health insurance.”

The Bill also seeks to make it mandatory for persons over 18 years to contribute to the fund, irrespective of their financial capability.

This amendment has, however, been opposed by Kikuyu MP Kimani Ichung’wa, who wants the age limit to be removed.

“Where do they expect Kenyans, who are 18 but not employed, to raise the money from. The contributions should be made mandatory to those in employment,” he  said.

The National Assembly Health Committee has also opposed the proposal to make it mandatory for persons over the age of 18 to contribute to the Fund.

Atwoli said  the amendment bill seeks to change NHIF from a fund to a scheme and by and large changing the mandate and objective of the NHIF as it were previously.

The unionist said any attempts to disband the NHIF, as envisaged in the proposed amendments, will leave workers under the umbrella of COTU-K with no other option but to move to court to seek orders to annul any such attempts. 

FKE has opposed the proposal to have employers make matching contributions to the NHIF saying this will not only affect the wage bill but also the capacity of businesses to create new jobs.

The employers’ body wants MPs to reject the proposal in the Bill compelling them to match their workers’ NHIF contributions, saying it will be an added burden as they struggle to recover from the effects of the coronavirus pandemic.

Further, the Bill seeks to make it mandatory for employers, including the national government, county governments and the private sector, to pay for their staff.

Currently, employers pay Sh1,200 for their workers while those in the informal sector who voluntarily join NHIF pay Sh500 a month.

Garissa Township MP Aden Duale is seeking an amendment to have the national government made liable as a contributor to the Fund in respect of all public officers, state officers and employees working in the national government and national government entities.

Duale’s amendment is, however, seeking to give reprieve to employers by exempting them from paying matching contributions, in case an employer has procured a private health insurance cover for the employees and the benefits thereof are equal to or better than those the employees are entitled to.

Chepalungu MP Gideon Koskei has moved an amendment to have the minimum amount of contribution payable to the Fund to be Sh300. “Kenyans are currently struggling to survive and asking them to pay Sh 500 to the Fund will only add to their miseries,” Koskei said.

Defaulters warned

The Bill seeks to buy from the National Social Security Fund (NSSF) module where the employer matches the employee’s monthly statutory deductions.

In the private sector, employers will be liable to pay 50 per cent of their contribution in the first year from the date of commencement of new law.

“In the subsequent second year, the employer shall be liable to pay seventy five per cent (75 per cent) of the employer’s contribution while in the third year and subsequent years; the employer shall be liable to pay the full employer’s contribution matching the employee’s contribution,” reads the amendment.

Many businesses opt to buy private health insurance schemes for their employees and paying for the National Fund is going to raise the cost of doing business by raising the wage bill.

Employers who default on payments are liable to pay a penalty of 25 per cent of the outstanding contribution and also foot all medical bills for workers who fall sick within the default period.

Cotu has insisted the bill will force Kenyans to contribute towards NHIF without assuring them reliable services and transparency in the fund.

“NHIF should not be obsessed with collecting more money but using the fund collected effectively.

It is also wrong to use laws to coerced Kenyans to contribute to any scheme,” Atwoli protests.