NATIONAL SOCIAL HEALTH INSURANCE IN KENYA

The 1978 declaration of Alma- Ata defines health as.”A sate of complete physical, mental and social well being, and not merely the absence of diseases or infirmity. The declaration also identifies health as one of the most basic human rights and goes further to propose, “…the attainment by all peoples of the world by the year 2000of a level of health that will permit them to lead a socially and economically productive life.”

Early in the year the Kenyan government, through the Ministry of Health, announced its intention to provide free heal care for its citizens. This sparked charged debate and opposition from various sectors. The ministry of Health went ahead to announce that, with effect from July1, 2004, access to medical services from any government health institution would be free of charge. However noble this declaration was, it represented more questions than answers. The bill is currently being debated before parliament for enactment in to law. It would be unlawful for any contribution be collected from citizenry without this bill being passed into law.

The history Of Social Health Insurance In Kenya

At independence, the pledge of the founding fathers was to rid the country of poverty, disease and ignorance. In 1966, three years after independence, government introduced as an obligatory scheme where all individual earning above a specified monthly income would contributors and a specified number of dependants. The fund did not include not include contributions from employers of government.

In the first 20years of independence, the government provided support for expansion of health facilities and as such, NHIF grew and accredited both private and mission hospitals. However, the 1980s Structural Adjustment Programmes were introduced and given support by the International monetary Fund and the World Bank. This era also saw the introduction of the concept of cost sharing in public health. Presumably, this was meant to alleviate the government’s burden of financing public health services and to free government resources for debt servicing.

The nineties were ushered in with non- governmental organization and private health maintenance providers playing a more active role in the provision of healthcare. With time, the morality rates began to rise and more basic care. In spite of the private sector’s participation, the government still remains the biggest financier of healthcare.

Access To Healthcare For All

The Minister of Health –Hon. Charity Ngilu’s announcement of government’s intent to provide free healthcare for the nation has sent ripples through the country. In a matter of days an e-mail entitled “the great rip-off by the so-called ‘Kenya government” hit the mailboxes of corporate Kenya. The e-mail pointed out the “evils” of the proposed scheme and called for mass opposition of the NSHIF.

Some private hospitals, accredited by NSHIF, openly opposed the plan and declared their unwillingness to participate in implementation of the scheme. The Central Organisation of Trade Unions came out very strong against the plan; the Kenya National Union of teachers threatened strike action if government proceeded with implementation of this scheme.

Accusations were hurled across the various sectors, with the supporters of the scheme accusing the opposes of thinking only of their profit margins, and the opposers accusing the supporters of greed with the aim of robbing the Kenyan people of their hard earned money through additional taxation to finance the scheme.

With about 57% of the population living below poverty line, most Kenyans cannot afford the most basic healthcare. in addition, the rapidly increasing prevalence of HIV/AIDS has added to the already strained health budget and has caused the government of the day to declare a state of emergency. All are in agreement that the need for basic healthcare in Kenya is indisputable, so why all the fuss?

Financing

The government has estimated that it will require 40 billion Kenyan shillings annually to make free healthcare possible. It plans to contribute 75% of this amount, with the remaining 25% coming from the private sector. Employees will make a mandatory contribution of 3% of their gross monthly pay and for the first time in the history of social insurance the employer will contribute 6% of gross monthly pay for each employee.

The NSHIF bill also proposes to place a health tax on tourists. Tourism one of the largest sources of income for the country. The past few years have seen the country besieged by terrorist activity, which led to a slump in the number of visitors entering the country. The tourism industry is just regaining its past glory and many feel that placing taxation on Kenya’s visitors at this time would jeopardize the growth of this sector.

Presumably, members of the population that live below the poverty line would be exempt from tax. This would significantly decrease the number of people within the taxable bracket. The slow economic growth rate has pushed many Kenyans into informal employment whereby registration for taxation does not take place. The government is yet to tell its people how it proposes to incorporate this group into its plans. This essentially means that the small percentage of those in the formal sector will be heavily taxed to, make up the 25% contribution from the private sector. Of special concern to the man on the street is the NSHIF Board’s authority to increase or decrease contribution as it sees fit.

Even though this contribution is mandatory, the bill does not preclude any member from seeking private health insurance. For many Kenyans this is adding insult to injury. What the government proposes to collect from them is about the same as what they would contribute to obtain private health insurance. If the scheme takes off, they will not be able to afford private healthcare and for many, the alternative-government facilities-is not an option.

Administration

The administration of this scheme will be handled by the existing NHIF structures currently experience a fraud rate of about 30% and only manage to collect slightly above half of the expected revenue. The organization spends a large portion of its revenue on administrative costs and has a relatively poor track record in terms of claims processing and payment.

The NHIF Scheme has a membership base of approximately 2 million contributions and only offers an inpatient package for contributors. The NSHIF proposes to include the outpatient package for contributors. The NSHIF propose to include the outpatient component and in crease its coverage to approximately 30 million people. The potential for fraud is frightening.

As if this were not enough, government facilities are famous for inadequate upkeep of their health amenities i.e. infrastructure, equipment and staffing levels.

Source: The healthcare Journal August 2005- November 2005 edition