The four health bills driving Universal Health Coverage

Kenya enacted four health bills that flagged off the journey to Universal Health Coverage (UHC). These included the Primary Healthcare Act, Digital Health Act, Facility Improvement Financing Act and Social Health Insurance Act.

Before this, healthcare contributions were made to the National Health Insurance Fund (NHIF) with mandatory deductions for formal employees and voluntary payments from self-employed and informal workers.

These contributions financed public healthcare services as very few private facilities accepted NHIF or would require a co-payment method. The insurance penetration rate in Kenya is low at an estimated five per cent according to Kenya’s Insurance Regulatory Authority (IRA). This meant that most Kenyans pay out of pocket for healthcare expenditure.

Facility Improvement Financing Act

Perhaps the simplest is the Facility Improvement Financing Act which provides for revenues collected from services or raised by public healthcare facilities to be utilised by the facility.

This facilitates independence and operational efficiency by allowing facilities to directly reinvest their generated funds based on needs. Three of the health Acts were to become effective in November 2023. The Social Health Insurance Act, Digital Health Act and Primary Health Act set the course to revolutionise the healthcare system in Kenya.

However, the High Court issued a conservatory order restraining the government and its agents from implementing or enforcing the relevant Acts of Parliament. A decision by the Court of Appeal in January 2024, lifted these orders which gave the green light for the Social Health Insurance Act to replace the NHIF Act.

The Social Health Insurance Act

The Social Health Insurance Act established the Social Health Authority (SHA) under which three funds have been created: The Primary Healthcare Fund, the Social Health Insurance Fund (SHIF), and the Emergency, Chronic, and Critical Illness Fund. All the funds, assets and other property held by the NHIF Board vested in the Social Health Authority effective November 22, 2023. The NHIF Board is required to wind up the National Hospital Insurance Fund within one year from the stated effective date but the National Health Insurance Fund Act, 1998 is repealed.

Primary Healthcare Fund and the Emergency, Chronic and Critical Illness Fund

The Primary Healthcare Fund and the Emergency, Chronic and Critical Illness Fund were to be financed by the government. SHIF is contributory, meaning that each citizen above the age of 18 years old and any resident of Kenya for over 12 months, would be required to make payment – either through monthly deductions if in formal employment or annual contributions for non-salaried households.

Financial risk protection

Some of the questions Kenyans raised included: Should they should stop making NHIF contributions? Why was there a fresh registration exercise? How was SHIF going to capture contributions from informal workers, most of whom survived on daily wages?

The importance of an education exercise became clear. It was no easy feat that the government was undertaking. To aid in clarity, Kenyans need to be aware that the Health Acts would first need regulations that would guide how the Act would be operationalized and implemented. The Social Health Insurance Act regulations gazette was issued on March 8, 2024. In the next column, we shall take a deep dive into these regulations and explain the deductions to be made from households with salaried income vs those without salaried income.

I urge you to remember that as discussed in the previous column UHC seeks to address three components. The first is access to health services where everyone who needs services should get them, not only those who can pay for them. The second is financial risk protection where people should not fall into debt paying for treatment and care. The third is quality, where services should be adequate and effective. It is a steep mountain to climb, but Kenya has a fighting chance. The three pillars of UHC are service delivery, financing, and governance. All three need to be addressed in parallel and this requires patience.

Dr Wangari is a medical doctor. @diana1wangari