The recently released guidelines by the National Hospital Insurance Fund (NHIF) on 7th January 2020 provide a bleak picture into the future that envisioned Universal Healthcare Coverage (UHC) in Kenya. One of the changes is the reduction of the waiting period for new members from the current 60 day period to 90 days. There is also a mandatory 1 year upfront payment. For those defaulting on the payments, the changes provide for a penalty of 50% of each monthly contribution paid late for up to 11 months. Where the contributor has defaulted for 12 months, they will be required to start payments afresh and will only be eligible to benefits after 90 days from the date of resumption of payment. They will also pay a 1 year upfront payment. The rationale behind these changes is to marshal the efforts of NHIF towards the achievement of sustainable UHC and to enhance member retention. But is this really so?
Article 43(1) of the Constitution of Kenya 2010 provides that every person has the right to the highest attainable standard of health that includes the right to healthcare services. This is reiterated in the African Charter for Human and People’s Rights under Article 16.
The right to health is crucial to the realization of other fundamental rights and freedoms envisaged by the Constitution. Without it, one cannot be able to fully to enjoy their right to live fully. This right has four key elements that determine whether it can be enjoyed to the fullest. These are availability, accessibility, acceptability and quality. Availability connotes the present functioning public health and healthcare facilities for the use by the public. Accessibility takes different forms; the main ones being non-discrimination, physical accessibility and economic accessibility. Acceptability is with regard to being respectful of culture, minorities, peoples and communities. Quality relates to the scientific and medical appropriateness of the labour, equipment and drugs in the facility.
However, this is not the case as we know it. Almost daily, there are cries and complaints regarding the shortage of drugs in hospitals, shortage of beds in wards leading to even more deadlier cross-infections, lack of proper equipment to either detect or control certain diseases, long lines and wanting customer service to patients seeking assistance in healthcare facilities.
We acknowledge that indeed the realization of economic and social rights is contingent upon the availability of resources at the State’s disposal. Some might argue that limited financial resources at NHIF have necessitated these changes. However, what the Ministry of Health and its parastatal have shown Kenyans in the past 3 years is that there is little regard for taxpayers’ money. The much that has been given before has been mismanaged, misused and plundered massively leading to the current sad state of healthcare. A healthcare for the select few.
At the 2019 Kenya Health Forum convened by the Ministry of Health between the 14th and 15th of August, Health Cabinet Secretary Sicily Kariuki stated that, “UHC means much more than healthcare. It means ensuring that all Kenyans can get quality health services; where and when they need them, without suffering financial hardship. This has also been a key objective of UHC under the Big 4 Agenda that the Government is currently driving: that there may be a realization of a society where no one is ‘left behind.’
These changes are discriminatory not just to those who are not able to afford these services under this punitive regime, but also to women. Most new members of NHIF during the financial year 2017/2018 were citizens from the informal sector with a 13% increase from the previous year. It is evident that people in informal sectors and those struggling financially will be the first casualties. Their inability to meet these high costs will certainly leave them behind and result in unnecessary deaths that can be prevented through proper treatment. On the other hand, for voluntary members, access to maternity will be restricted to 6 months post card maturity. What then happens to expectant mothers who cannot afford the exorbitant costs of private hospitals? They will be denied adequate health services or pay hefty prices and end up suffering financial hardship in their quest for better healthcare.
The question that therefore arises is, who then speaks for citizens’ welfare? There exists, in both the National Assembly and the Senate, a Departmental Committee on Health that deals with matters of national health. These Committees are mandated to cover the functions of the Ministry of Health alongside its semi-autonomous Government agencies including the National Hospital Insurance Fund. Besides that, the Committee has a duty to investigate, inquire into, and report on all matters relating to the Ministries and departments as they deem necessary and as may be referred to them by the House. It also has a duty to study the programme and policy objectives of the agency and the effectiveness of the implementation.
Once Parliament resumes from recess, Members of the Health Committee in the National Assembly should take up this matter and represent the interests of the people. Some of the recommendations the Committee can propose to NHIF include; reduction of the premiums and elimination of the 1-year upfront payment, reduction of the waiting period, promotion of prompt disbursements of payments to healthcare providers, regular monitoring on the quality of services offered in accredited healthcare facilities and stringent rules on the management of financial resources at the Fund.
According to the Kenya National Bureau of Statistics, the overall membership of NHIF in the year 2017/2018 increased from a total of around 6.8million to 7.7 million. There is a high probability that the number is much higher now following the 2019 population census. These new changes spell doom for healthcare in Kenya and are actually parallel to the efforts of attaining UHC. The State in itself has an obligation to take necessary measures to protect the health of its people and to ensure that they receive proper medical attention. More can be done if there is right leadership and proper public participation.
Let healthcare be affordable for all; not just a select few. That is the Universal Health Coverage that Kenyans deserve.