Health CS nominee Kagwe roots for compulsory NHIF contributions

The voluntary contribution approach has proved to be ineffective

In Summary
  • Nominee hopes to follow the route taken by California, Thailand and Saudi Arabia where health insurance is mandatory.
  • The police, MPs and teachers are among state officers covered by private insurers and not NHIF.
NHIF building./FILE
NHIF building./FILE

Health Cabinet Secretary nominee Mutahi Kagwe is spoiling for a fight with private health insurers with his proposal for radical changes at the NHIF.

Kagwe, who was being vetted by the Committee on Appointments yesterday, told MPs he intends to bar government agencies from seeking medical cover outside the National Health Insurance Fund.

His proposal is that contributions should be mandatory since the voluntary approach has proved ineffective.

The former Cabinet minister and Nyeri Senator says the mandatory regime is the sure way of increasing citizen contribution to fund the health sector.

The Fund is in a cash crisis blamed on corruption and mismanagement.

The management has, for instance, denied that it spent Sh6 billion from the reserve fund to print AfyaCare cards for counties.

Kagwe argues that NHIF needs an increase in revenue from the base as “Kenya is not a rich country to give healthcare services for free.”

He blamed the NHIF cash crisis on the state reliance on the private sector for insurance services.

The police, MPs, and teachers are among the many government employees that were removed from NHIF as the sole insurer.

But Kagwe told the vetting committee chaired by Speaker Justin Muturi that he wants state officers compelled to seek services in public hospitals.

“Let us go to KNH with NHIF cards. It will be possible to build social insurance if we go in that direction. Let government funds be used at NHIF,” the nominee said.

He said California, Thailand and Saudi Arabia had mandatory health insurance regimes. He intends to borrow from their success.

“Citizen responsibility is part of our contribution. If someone can afford 10 beers, they, therefore, can contribute to the Fund.”

The incoming CS wants MPs to come up with legislation so that those who are able – the rich, pay more contributions "to take care of the least able".

He held that NHIF cannot continue to operate as corporate insurance and that it should not be managed under the Companies Act.

“We can't make social insurance work like a cooperate entity. We will put a CEO in place and ensure the Fund serves the wananchi.”

The intention is to restructure the fund as well as use technology to limit face-to-face interaction between the fund managers and clients. Paperwork should be done away with, he said.

Speaker Muturi and Kikuyu MP Kimani Ichung’wa backed the proposal, saying there will be great progress if, for instance, MPs pay more to the Fund.

“NHIF monies should be to help the country improve healthcare and to help citizen access treatment. If we commercialise, we lose the social aspect and kill the initial desire,” Muturi said.

More trouble looms for the cartels perpetrating graft at Afya House – the nominee pledged to take them head-on.

He promised to infuse professionalism in the system and to employ a bottom-up budgetary approach to tame corruption.

“I intend to use my experience to make things better. I intend to centralise e-health, infuse ICT to help fight corruption and use resources better.”

He plans to engage county governments on the possibility of reverting some health functions to the national government.

Kagwe says that if confirmed, he will ensure allocations to projects will be based on the need basis, factored on empirical data – collected at source using technology.

“Should the House approve my appointment, I will take this task seriously. I know there will be resistance but I believe that this is not a popularity contest,” the CS nominee said.

Kagwe backed the proposal for a private hospital at KNH, saying the money sourced from the wealthy who visit the facility can be used to fund operations at the main hospital.

He pledged, among other issues, to deal with is the proposal for the human resources element of health function to be reverted to the national government.

Kagwe promised to streamline Kemsa through a centralised purchase system where supplies are driven by requisitions.

“The time has come for talks between counties and national government on workings of the new dispensation. Let's discuss what each arm can do better,” he said.

Kagwe, if approved, would be the fourth minister to steer the ministry whose operations are marred by rampant doctors’ strikes, audit queries, and corruption allegations.

There is an ongoing investigation by the Senate into the procurement of leased specialised medical equipment for counties.

He also faces the mammoth task of implementing the Universal Health Coverage (UHC) – which is among President Uhuru Kenyatta’s legacy projects.

Also vetted was the Industrialisation and Trade CS nominee Betty Maina, who promised to support the growth of SMEs, local industries, and improvement of trade ties between Kenyan and her partners.