In the new Universal Health Coverage plan, the Emergency, Chronic and Critical Illness Fund will pay the bills the moment the social health insurance is exhausted.
The burden of cancer, which costs Kenyans about Sh10 billion a year in medical tourism to India, will be taken up by the new fund.
The emergency fund will also take the pressure and load off hard-up and poor patients and relatives because no patient will be denied treatment for chronic and emergency situations.
This will be a major relief for road traffic accident victims whose lives, after a crash, are dependent on public hospitals first verifying whether they can pay and the long waiting that sometimes leads to death as a result of demands for cash for every test conducted.
President William Ruto’s UHC vision began Thursday when he signed four bills to change health care in the most radical fashion in 60 years.
The Sh500 billion plan will largely be financed through increased taxes.
The government has already proposed employed Kenyans pay 2.75 per cent of their gross salaries every month. Those outside of formal employment will go through an income assessment to determine how much they will pay. The least will pay Sh300 a month.
Ruto said the most important move was to end out-of-pocket expenditure, especially when treating chronic diseases such as cancer.
"Our national healthcare journey has been long and at times painful. Indeed, most Kenyans have always insisted that healthcare is the public service they want the most; it is the priority. Today, we talk about chronic diseases," he said.
By 2020, most Kenyans who travelled to India had cancer (36 per cent), followed by cardiovascular diseases (19 per cent), musculoskeletal conditions (13 per cent), renal ailments (12 per cent) and central nervous system conditions (nine per cent), said a health standards unit headed by Dr Patrick Amoth, acting director general for health.
There have been growing calls to declare cancer a national emergency.
The new laws will cater for chronic and non-communicable diseases even when Kenyans exhaust their insurance contributions.
Health officials are next week travelling to Mombasa to fine-tune standards and guidelines that will operationalise the four health acts signed by President Ruto.
The President signed the four acts at State House on Thursday, setting the stage for the biggest health taxation in history.
Draft regulations show the government plans to tax employed Kenyans 2.75 per cent of their salaries every month.
This will raise Sh500 billion every year to fund Ruto's dream of Universal Health Coverage.
The new tax, coming on the heels of other new and increased taxes, has been criticised as excessive.
Still, the President praised the new move, and is expected to launch the UHC plan officially in Kericho on Friday during the Mashujaa Day celebrations.
"The people of Kenya talked loudly for a system that leaves nobody behind, where families do not lose their properties or savings due to illness," he said at State House after assenting to the bills.
The new laws are the Social Health Insurance Act, Digital Health Act, Primary Healthcare Act and the Facility Improvement Financing Act.
President Ruto said the UHC plan was put together in the last two years, ahead of campaigns, adding that no one knew the plans were going to be laws in Kenya.
"My team of advisers was so committed to this plan, not forgetting the team in Parliament who has delivered. I also want to congratulate the creativity of Parliament, MPs gave the amendment they wanted to the Senate and vice versa to improve the quality of this law," he said.
Key of the four laws is the Social Health Insurance Act, which will kill the National Health Insurance Fund and replace it with three new funds.
A Ministry official told the Star that President Ruto is keen to have the four acts operational by December.
The standards and guidelines being developed will need to go through public participation and be adopted by Parliament.
Dr Daniel Mwai, the President’s adviser on health, said the new Social Health Insurance Act will ensure everyone participates in health financing.
“For long this country’s health insurance was only centred on the employed, 20 per cent of the population, but now we have found ways to enable the remaining 80 per cent to participate," he said.
The new Act establishes a social health insurance authority, which will administer three funds: the Primary Healthcare Fund, a social health insurance fund and a new Emergency, Chronic and Critical Illness Fund.
The new authority will come with bad news for the current employees of the NHIF, who will be forced to reapply for jobs.
“The board of the Social Health Authority established under Section 4 of the Act shall competitively recruit and appoint its staff under Section 17 of the Act, subject to the approved staff establishment and on such terms and conditions of service as may be determined by the Board,” according to the Social Health Insurance Act, 2023.
“A staff of the Fund not appointed by the authority may exercise his or her option to either retire from public service or be redeployed within the public service.”
Nairobi Senator Edwin Sifuna faulted this move.
"If people were already working for an organisation, they were vetted and are qualified, why would you subject them to a re-application process? This is what is causing jitters within NHIF. If these people were competitively recruited, they should automatically be absorbed into the new fund," he told the Star.
The Social Health Insurance Fund is the monster among the three Bills, to which the government has proposed Kenyans contribute 2.7 per cent of their salaries.
Contributions, in the case of a household with an employed head, will be paid through a monthly statutory deduction.
Non-salaried individuals will make an annual contribution as determined by the regulations being crafted.
These contributions will also cover indigent and vulnerable persons.
“Every Kenyan shall register as a member of the Social Health Insurance Fund,” the new law says.
A child born after the commencement of the Act shall be registered at birth as a member of the Social Health Insurance Fund.
“Any person who is registerable as a member under this Act shall produce proof of registration with the Social Health Insurance Fund as a precondition of dealing with or accessing public services from the national government, county government or national or county government entity,” it adds.
The primary healthcare fund will raise money from the exchequer.
It is from this money that primary health facilities and community health promoters will be funded.
There is also a new Emergency, Chronic and Critical Illness Fund, which will defray the costs of management of chronic illnesses after depletion of the social health insurance cover and also cover the costs of emergency treatment.
This will be financed by the National Assembly, donors and any other contributors.
The Primary Healthcare Act aims to strengthen preventive health services by the cooperation of the 100,000 community health promoters recently commissioned by the President.
The Facility Improvement Financing Act will restrict funds raised in public health facilities so those funds are not put to other uses outside of health.
The Digital Health Act aims to promote telemedicine and digitise health services by ending written transactions.
“We have ensured we’re taking care of the privacy of data such that health workers will only have access to only data they need. This will ensure full accountability,” Health CS Susan Nakhumicha said.
