Ruto’s Kenya Kwanza administration has proposed several changes to the law to radically transform the crucial sector.
In the reforms, the President targets primary health care, health insurance, health facilities and digital provision of services.
The changes are contained in four Bills that were early this week endorsed by the Cabinet during a sitting at Kakamega State Lodge.
They are The Social Health Insurance Bill, 2023, The Primary Health Care Bill, 2023, The Digital Health Bill, 2023 and The Facility Improvement Financing Bill, 2023.
The draft Bills as set to be sent to Parliament for consideration by the Senate and the National Assembly.
Insiders intimate that the President is keen to have the Bills passed by Parliament and signed into law before Mashujaa Day slated for Kericho county next month.
The theme of this year’s Mashujaa Day is Universal Health Coverage.
There will be a one-week health conference before the Mashujaa Day celebrations.
Ruto is expected to launch the countrywide rollout of UHC during the celebrations.
Previous attempts by the former regime to roll out UHC aborted.
In the Social Health Insurance Bill, 2023, the government creates the Social Health Insurance Fund (SHIF) to replace the National Health Insurance Fund (NHIF).
“The principal object of the Bill is to put in place a legislative framework to regulate the provision of social health insurance, promote the implementation of the UHC and to ensure that all Kenyans have access to affordable and comprehensive quality health services,” the Bill states.
The NHIF Board is also being replaced by the Social Health Authority.
The Authority shall among others register beneficiaries, manage the fund, contract healthcare providers and advise the Health CS on matters health insurance and formulation of policies.
The Bill changes the contribution model towards SHIF, from the current flat rate of Sh1,700 to a percentage of one’s salary.
It’s reported that up to 2.75 per cent of an employee’s salary would be deducted towards the SHIF, with minimum contribution capped at Sh300.
However, the percentage is not expressed in the Bill.
“We are changing the funding system so that we can allow the vulnerable to access NHIF free of charge and those who are in the lower category to pay less and those who earn more like me to pay more,” Ruto said in Western early this week.
The Bill states that a household whose income is derived from salaried employment will contribute a monthly statutory deduction from the wages or salary by the employer.
In the case of a household whose income is not derived from salaried employment, contribution would be by an annual proportion of household income as determined by the ‘means testing instrument.’
“In the case of households in need of financial assistance as determined by the means testing instrument, by the government at a rate apportioned from funds appropriated by Parliament and County Assemblies for that purpose,” the Bill states.
It provides that a person shall only access healthcare services under this Act where their contributions to the Social Health Insurance Fund are up to date and active.
“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 10 per cent of the amount due for contribution for the period which the contribution remains unpaid and the total annual contributions,” it states.
The Bill establishes a separate fund for chronic and critical illness and emergencies to defray the costs of management of chronic illnesses after depletion of the social health insurance cover.
Further, the Bill introduces a Claims Management Office within the Authority to review, process and validate medical claims from healthcare providers and healthcare facilities.
The Primary Health Care Bill, 2023 roots for the provision of primary health care at the community level – with the help of community health workers and the lowest facility.
“This Bill seeks to establish a framework for the delivery of and access to and management of primary healthcare,” it states.
“The framework creates an elaborate primary healthcare network at each county and subcounty level to ensure equitable distribution of resources and health services.”
There shall be opened a facility improvement financing account for each public health facility into which shall be paid all monies received by or on behalf of all public health facilities
In the Bill, the government seeks to hire 100,000 community health promoters whose roles shall include health education and promotion, disease prevention and control and family health services.
A community health promoter shall be selected by the community through a public participation forum and appointed by the county government.
The promoters shall be registered by directors of health in all 47 counties who shall keep and maintain a register of all community health promoters working in the county.
It mandates county governments to support the provision of primary healthcare by among others adopting supportive and innovative modern approaches for disease identification and monitoring.
The Bill established a Primary Healthcare Advisory Council at the national government that advises the national and county governments on implementation of primary healthcare services.
The Facility Improvement Financing Bill, 2023 allows the management of public health facilities to retain all the money they raise or receive for improvement of services and facilities.
This will be in addition to the funds they receive from the county and national governments in their annual budgets.
Currently, the health facilities are required to wire all the money they raise to the county revenue fund accounts before the same is requisitioned by the executive.
“There shall be opened a facility improvement financing account for each public health facility into which shall be paid all monies received by or on behalf of all public health facilities,” the Bill states.
The finances retained by the public health facilities shall be used to support their optimal operations for effective service delivery throughout the financial year.
The move is aimed at curbing the arbitrary diversion of funds meant for health provision by the county and national governments.
The Bill provides that the national government, through the Ministry of Health, shall provide policy and regulatory direction in the administration of facility improvement financing.
The counties, on the other hand, shall be responsible for facilitating the effective collection and retention of facility improvement financing revenue by public health facilities.
In the Digital Health Bill, 2023, the state seeks to provide a framework for the provision of digital health services.
It also seeks to establish a comprehensive integrated digital health information system, data governance and protection of personal health information and service delivery through digital health interventions.
The Bill creates a Digital Health Council that will administer the integrated health information system established in the Bill.
“The system shall operate as a point of collection, collation, analysis, reporting, storage, usage, sharing, retrieval or archival of data,” the Bill states.
The system shall contain data related to the state of physical or mental health of the data subject and include records regarding the past, present or future state of health.
The Bill provides for governance of the health data whose custodian shall be the Health cabinet secretary in the country, with Health CEC taking charge of the data in the counties.
“The Cabinet Secretary shall ensure that Health data is used for public good and not for commercial purposes,” it states.
