How the new NHIF laws will affect Kenyans

Kenya plans to build at least one health facility for every 5,000 of its citizens under the ambitious universal health coverage (UHC) programme to be launched by President William Ruto on Friday.

The Primary Health Care Act, 2023—one of the four health laws signed by President William Ruto on Thursday— provides for the construction of community health units across the country to facilitate delivery and access to primary health care services at the grassroots.

“A community health unit shall serve a catchment population of up to five thousand persons in accordance with national guidelines,” says the new law.

The health units will be set up by the 47 county governments, which will be expected to closely work with the national government to ensure the success of the UHC.

The new Act defines a community health unit as one with 1,000 households.

Each will be under a community health committee and will be linked to a healthcare facility.

Read: How draft NHIF rules will shake up contributions

Other Bills that were signed into law on Thursday are the Social Health Insurance Act, 2023, the Digital Health Act, 2023 and the Facilities Improvement Financing Act, 2023.

Should Parliament approve the regulations that will anchor the new laws, formal workers should expect to contribute 2.75 percent of their gross monthly pay to a Social Health Insurance Fund to finance the new UHC plan.

Contributions for Kenyans in the formal sector will be pegged as 2.75 percent of monthly pay while those for the informal sector will be Sh500.

The national and county governments will pay contributions for needy Kenyans.

Contribution to the fund will be mandatory for all adults seeking government services.

The new laws also will make it compulsory for all foreigners visiting the country for more than 12 months to enlist and contribute to the social health insurance scheme.

Visitors coming into the country for less than a year will need to buy travel health insurance, which must be recognised under Kenyan insurance laws and regulations.

To shield the scheme from corruption, those suspected of defrauding the health insurance scheme, through false statements risk being jailed for five years or fined Sh1 million or both.

The current National Health Insurance Fund (NHIF) is expected to be fully wound up by October 19, 2024, and it will transfer all the cash balances to the Social Health Insurance Fund.

The plan is critical in helping Kenya move closer to the globally accepted ratio of health access as set out by the World Health Organisation (WHO).

But the plan presents one of the biggest tests to Dr Ruto’s healthcare promise given the poor state and uneven distribution of the health facilities in addition to the shortage of healthcare workers, estimated to be hundreds of thousands.

A report by WHO shows that Kenya has 13 doctors, nurses, and midwives for every 10,000 people, which is below WHO’s standard of 23 doctors, nurses and midwives for every 10,000 people.

The Ministry of Health early this year revealed plans to hire some 20,000 healthcare workers to plug the shortage, but the recruitment is likely to be pegged back by limited funding.

Besides the shortage, the poor state of public health facilities has over the years prompted Kenyans to seek treatment at private facilities.

Kenya had 189,932 health workers in 2020, with 66 percent being in the public sector segregated into doctors at seven percent, clinical officers at 13 percent and nurses at 58 percent.

Dr Ruto while signing the four laws said Kenya was now set for a revolution in the public health sector as he gets down to implement an idea that has been piloted in Machakos, Kisumu, Isiolo and Nyeri counties.

“These four laws and regulations that will be formulated later will lay a firmer foundation for the biggest change in the way Kenya provides healthcare to her people,” Dr Ruto said.

While lauding the ambitious requirement, the Kenya Medical Practitioners Pharmacists and Dentists Union (KMPDU) said that the government must make massive investments in personnel and facilities.

Read: The good, bad of Social Health Insurance Bill

“It is a good ambition but for it to work, there is a need for massive employment of skilled health workers. The facilities must have the right personnel in addition to the drugs and equipment,” KMPDU secretary-general Davji Atellah said.

“There is a need to have doctors to give the services, not just community health workers. Otherwise, Kenyans may still continue seeking treatment at private facilities.”

All visitors to Kenya will also be required to have travel medical insurance as the country joins the League of developed nations in demanding the cover.

UHC will be modelled on three separate funds—one for preventive and primary health care, another for primary referrals and a third covering treatment of chronic diseases.

The State will also create a data pool that will have information on all patients who seek treatment at health facilities contracted by the State insurer, in what is expected to significantly boost treatment on readily available patient history.

→ (email protected)