Explainer: What new Social Health Insurance Act entails

This is an Act of Parliament that seeks to make healthcare affordable and accessible to Kenyans.

It establishes a Social Health Authority that will oversee the implementation of the Act. It introduces three new health funds that will replace the existing National Health Insurance Fund Act that has been in existence for 25 years now.

They include the Social Health Insurance Fund, Primary Healthcare Fund and a Chronic Illness and Emergency Fund.

Social Health Insurance Fund

Who can join it?

• All Kenyan adults and newborn babies are eligible to be part of this Fund.
• Newborns shall be registered for the insurance immediately after birth by virtue of being a member of a household.
• Foreigners who have been living in the country or intend to stay for more than 12 months will also be compelled to sign up for this Fund.
• However, foreigners who will be staying in the country for less than 12 months will be required to carry their travel health insurance to cater for their medical bills.

Who will contribute to the Fund?

• Kenyans in formal employment will make monthly contributions. The amount will be decided and announced in due time after all the regulations have been set by the government.
• What we know so far is in regards to what the President mentioned - that households will be required to pay a minimum of Sh300 every month. However, there is no hint of the maximum figure just yet.
• Foreigners who have been residing in Kenya or intend to stay in the country for more than 12 months shall make annual contributions.
• The government will make payments on behalf of non-salaried households as well as prisoners.
• Employers, the national and county governments will also add to the Fund’s basket.

Only members of the Fund who actively contribute shall access health services.

Also Read: Cabinet approves scrapping NHIF, to be replaced by three new Funds

What happens if you default on your payment?

Those that fail to pay on time will incur a penalty of two per cent of the unpaid amount and two per cent of the total annual contributions.

“Any person who fails to pay any contribution in respect of any period on or before the day on which payment is due shall be liable to a penalty equal to two per cent of the amount due for contribution for the period which the contribution remains unpaid and the total annual contributions.”

Your details will not be updated unless you have cleared the outstanding balances and penalties.

What is the Emergency, Chronic and Critical Illness Fund?

This Fund takes care of people with chronic illnesses like cancer and accident victims. It seeks to provide money to manage the costs of such illnesses, including emergency treatment.

This is intended to bring an end to fundraisings for medical bills and the idea of being left poor just because you have an incurable medical condition or one that came unexpectedly.

The financing of the Fund will be blended and will come from money set aside by Parliament, gifts, grants, donations and endowments as well as any other lawful source.

What you need to know about the Primary Health Care Fund

It will be used primarily for the primary healthcare services in the country.

Some of the primary healthcare services include early diagnosis, early intervention in case there is an outbreak of a disease, and prevention of health conditions, mental health and well-being recognition, among others.

The money will also be drawn from a kitty set aside by Parliament, gifts, grants, donations and endowments or fees or levies administered to the fund.

The Digital Health Act

What new things does it bring to the table? 

Kenya will now have a Digital Health Agency under this Act. This Agency will ensure Kenya embraces electronic storage of data for our health records.

This new law establishes an integrated health information system, which allows Kenyans to access their healthcare records in any hospital they attend. The act also provides guidelines for how their data will be protected to avoid data breach.

It will ensure Kenyans embrace telemedicine, mobile health as well as e-learning.

What happens if your data is used in a wrong manner?

Should a patient’s data leak or be used inappropriately, the confines of this law allows one to sue the Digital Health Agency. 

How else will the data be used?

Since the health records will be digital, the Ministry of Health will use the data to understand the disease profile in the country and figure out what areas need to be addressed urgently.

Data submitted to the system shall be stored in the national health data bank and specific county data banks, which shall be established by the Health Cabinet Secretary. This data shall be stored in the system for at least 20 years, and only held beyond that period with authorisation of the law, the patient, or for purposes of research.

Also Read: NHIF employees to apply for jobs in new authority

What are the circumstances in which data can be assessed? 

It can only be looked into when a patient dies in questionable circumstances, their sensitive personal data may be shared by the data controller with specific associates.

Anyone who tampers with, loses, steals, shares health data without permission or shares with an unauthorised person will pay one million shillings or be imprisoned for at most 15 years, or both.

What is the Facilities Improvement Financing Act about?

This law states that funds that are derived from hospital activities shall be used specifically in the hospitals to supplement hospital budgets and not submitted to the county government as before.

It will basically ensure management of hospital resources remain within the precincts of the hospital. This allows hospitals the autonomy to make decisions regarding their revenue and will no longer be used as tools for resource mobilisation.

Each health facility shall be required to open a facility improvement account where the money collected shall be deposited. The monies shall be collected from user fees, equitable share by county governments, grants, donations and gifts.

The facilities may also use the money to purchase goods and services, to procure commodities, products and technology, and to source other needed resources for optimal operation.
Why do we have the Primary Healthcare Act

This law summarises the role that Community Health Promoters (CHPs) play in provision of primary health care. It will largely help in the implementation of a fully kitted preventive approach that will stop diseases from occurring in the first place.

What then will be the role of Community Health Promoters?

The CHPs shall be responsible for educating the public about family health, environmental health, hygiene, first aid, psychosocial support and referrals. They are also tasked with managing the health data of community members.  This is all aimed at preventing diseases and resultant illnesses, disabilities and deaths.

How different will they be from the defunct Community Health Volunteers?

"Unlike before where CHVs only walked to people's households without proper equipment. The government has now given CHPs working tools  in line with the latest technology that they will use to identify and monitor diseases and share the information with primary healthcare facilities.

How many CHPs will be required in a particular area?

Each CHP will be responsible for 100 households. There shall also be community health units established by county governments that will serve up to five thousand people. This unit shall comprise about 1,000 households.

The unit shall then be linked to a healthcare facility to provide primary healthcare services.