Law changes will pave way for looting of NHIF

The front entrance of the NHIF building in Nairobi. There is a plan to make amendments to the NHIF Act. FILE PHOTO | NATION MEDIA GROUP

What you need to know:

  • The amendments to the NHIF Act seek to, among other things, expand the contribution base by roping in other sources including employers.
  • The net effect of these changes is to increase the money available for NHIF to use as they please.

There has been recent talk of the National Assembly planning to amend a raft of laws through a device known as a Statute Law Miscellaneous Amendment Bill.

Ordinarily, such a bill is meant to make minor adjustments to laws, including changing certain terms to conform with what is currently prevailing, and correcting inconsistencies in law that make it difficult to implement.

The fact that the changes are minor does not eliminate the responsibility of government to ensure that the amendments go through the requisite constitutional processes in order to safeguard the interests of the people.

Miscellaneous amendments, however, are not an avenue to make substantial changes to Statute Law as Parliament has attempted to do, often unsuccessfully, in the recent past.


The latest attempt affects numerous pieces of legislation, including laws concerning health financing, labour rights, and the governing structure of numerous government agencies.

To further confound the matter, these amendments have been shrouded in secrecy, and many of those affected will not have any idea that their world is changing substantially until the President assents to the bill and the implementers take over.

There are two particularly nefarious amendments that are being sneaked in without public participation or information.

The first one concerns the right to strike and the minimum durations of notice to strike, as well as the designation of several jobs as essential functions and restricting the workers rights to strike.


In fact, the civil matter of engaging in an unprotected strike, or even a protected one in essential services, has been criminalised with the imposition of a fine as well as a jail term.

While the government’s concern about the disruption to essential services during strikes is understandable, there are more amicable ways of dealing with this matter instead of going in this radical direction.

For instance, the greatest deterrent to unprotected strike action is summary dismissal without recourse to the justice system.

This, in my view, is a serious enough deterrent without resorting to criminal sanctions.

In any case, forcing people to work when they do not want to, especially in essential services, amounts to slave labour and can be more harmful than letting them go and keeping them away from the workplace.

A worker in a so-called essential service cannot be useful while working under duress.

The second set of amendments that are of particular concern to the health sector concern the National Hospital Insurance Fund (NHIF).

The amendments to the NHIF Act seek to, among other things, expand the contribution base by roping in other sources including employers, who are expected to match employee contributions.

Secondly, the scope of reimbursements is also being expanded to enable the Fund to enter into contracts with individual providers as well as with institutions, local and foreign.

None of these changes are, on the face of it, dangerous.

They will potentially expand the amount of money available for reimbursements as well as help improve access to healthcare for them as one of the pillars of Universal Heath Coverage (UHC).


The most mischievous and dangerous amendment follows these two, and involves the composition of the NHIF Board.

They propose to kick out from the Board representatives of professional associations, unions and faith-based organisations, among others, and to replace them with random ministerial appointees.

The net effect of these changes is to increase the money available for NHIF to use as they please, while reducing the oversight function of external stakeholders on the board.

To those of us with a sense of history, this scenario is not new.


Government agencies with lots of money are often fattened before the slaughter, and the slaughter results in gains for a few people and massive losses for those most in need.

At this critical moment we cannot allow some cynical fellows in government to use UHC as the excuse to loot from the national insurer just when its potential to do good is increasing exponentially.

As it is, none of the stakeholders will support the massive enrolment unless these amendments are shelved until consensus is reached.

Atwoli is an associate professor and dean of Moi University School of Medicine. [email protected]