Health ministry UHC meeting backs new taxes to fund NHIF

A meeting seeking funds for President William Ruto's Universal Health Coverage agenda has backed new taxes to raise the money.

The meeting, organised by the Ministry of Health, said the government should raise its allocation to the Ministry to 15 per cent of the national budget.

The ministry currently gets 11 per cent, most of which goes to salaries and independent agencies under it.

The meeting also advised counties to raise their health budgets to 35 per cent, up from the current 30 per cent.

"The Government of Kenya will increase domestic resources for the health sector through tax revenues, social health insurance revenues, strengthening private investment, and exploring earmarked taxes for health," the national statement released at the end of the three-day National Dialogue on Sustainable Health Financing in Kenya in Nairobi.

The statement was presented by Elizabeth Wangia, the acting director of health financing at the ministry.

It also recommended that Kenya progressively increases "the total government expenditure on health as a proportion of GDP to five per cent, allocation of the national budget of health to 15 per cent, and a progressive increase of county budgets to health to at least 35 per cent by 2030."

Deputy director of Health Sultani Matendechero said the ministry will ensure the recommendations are adopted.

The meeting began on Monday in Nairobi.

However, the World Health Organization warned Kenya to pursue only fair ways of raising money without hurting taxpayers. 

"Country needs to consider if the ways finances are raised is fair in order to finance the UHC," WHO said in a statement after the meeting released its declaration.

WHO said only two countries in Africa have managed to finance more than 70 per cent of their health budgets from domestic resources.

"Kenya has a total of 47  per cent of government spending in health. That shows the road to UHC is long," the WHO said.

"Countries make better progress when they rely on domestic finances and remove fragmentation."

It urged the country to ensure any funds raised are used prudently.

The government is looking at increasing contributions to the National Health Insurance Fund to raise money for UHC. 

The government has already proposed to tax Kenyans 2.75 per cent of their salaries to fund its scheme through the National Health Insurance Fund. 

The proposed tax will double NHIF contributions by jobless Kenyans aged 18 from Sh500 to Sh1,000.

Jobless people currently contribute Sh500 monthly but are most of the time unable to pay.

“A contributor who is not employed or listed as an indigent person or vulnerable person shall pay a monthly contribution of one thousand shillings,” clause 13 of the proposed NHIF regulations says.

A recent petition initiated by the rights group Amnesty Kenya noted several clauses of the regulations are not only draconian but will simply impoverish Kenyans.

“We cannot let these harmful clauses go unchallenged,” Amnesty said in the petition, which was presented to Health CS Susan Nakhumicha and board chair of the National Health Insurance Fund Michael Kamau last month.

“Access to healthcare is a human right that should not be denied or restricted by punitive clauses in legislation,” Amnesty added.

The often-cited Sh300 contribution is only reserved for employed people, where 2.75 per cent of their gross income would fall below Sh300.

“A contributor shall pay Sh300, where the amount in paragraph (1) is less than Sh300,” the bill reads.

Paragraph one of the regulations refers to the new 2.75 per cent of the declared or assessed gross monthly income of the contributor, one of the highest rates in the world.

It will also be difficult to prove you should contribute Sh300 because “the [NHIF] board may require the contributor to avail such evidence and documentation as the board may consider necessary.”

Amnesty said in total, there are 13 clauses that will limit access to affordable, quality healthcare.

The other clauses include denying treatment to dependents with sickle cell anaemia, and denying treatment to your partner if you are not formally married.

Calculations by the Ministry of Health show Kenya Kwanza's UHC plan will cost Sh550 billion a year.

Health spending in Kenya is about Sh247 billion, which must be doubled for this to be realised.

Affordable healthcare was a key plank in President William Ruto's campaign pledges.

Although the government is expected to increase contributions to the NHIF to raise more money, the ministry noted nearly half of all Kenyans live below the poverty line and struggle to pay the current premiums.

“As such, 5.3 million households require government subsidies for health insurance,” the ministry said in a technical paper presented at the National Dialogue.

In a speech read by Prime Cabinet Secretary Musalia Mudavadi, President Ruto on Monday said most of the UHC funds will go to primary health services.

"It has been demonstrated for every dollar invested in primary health care the return is 16 dollars," Ruto said.

He said national and county governments will jointly recruit and pay about 100,000 community health promoters to drive the programme.

"For once, all the 100,000 Community Health Promoters will receive a matching stipend from national and county governments," he said. 

Each community health worker will receive Sh5,000 a month, shared equally by the two levels of government

"Investing in primary health care will free resources that can be redirected to strengthening our health systems," Ruto said.