•NHIF has been given a bad name by some very bad employees, first of all those employees will not be onboard to SHA
•What has happened in the past is when someone anticipates the need to benefit from NHIF is when they pay premiums and after they have benefitted they opt out
Image: Magdaline Saya
On November 22, 2023, the Social Health Insurance Act 2023 came into force after being assented to by President William Ruto on October 19, 2023.
The Act led to the establishment of the Social Health Authority that will be a key driver in the country's dream to attain Universal Health Coverage agenda.
The authority which replaces the repealed Social Health Insurance Fund (NHIF) is headed by Timothy Olweny as the chairperson.
The SHA chairperson spoke to The Star health reporter Magdaline Saya on a number of issues and what Kenyans should expect even as the changes take effect.
What progress has been made since the authority came into place?
We have been involved in the process of transition. The transitioning from NHIF to SHA is supposed to take according to the law a maximum of one year so we are in the process of interacting with NHIF board. There is a transition committee which is appointed which is also supposed to help in the process of transfer of especially the assets, liabilities and any obligations between NHIF and SHA which is going to be the successor organisation.
There has been significant progress so things are on course in terms of the transition. The key thing is to ensure that we are having seamless transfer and continuation of services to the current members of NHIF who are going to be the members of SHIF so from the beneficiary perspective I don’t think they have noticed any change in terms of this corporate handover and that is the objective.
When are we expected to see the changes in terms of registration and contributions?
Registration is going to commence in the month of March, and then subsequent to that in the new financial year is when we are going to have the new rate of contributions commence.
It was set for the beginning of the new financial year for reason; That is the time we can have funds appropriated to the SHA through Parliament because the funds are significant so is not easy to be appropriate through a supplementary budget.
It also gives us enough time to be able to ensure that we get all the new schemes in place.
As you are aware we have a new benefits package which is expanded so it is a wider mandate and that is why we have chosen to take our time about it to make sure when we implement it we implement it in right manner.
Were there any issues of contentions from Kenyans public participation forums on the new regulations?
I wouldn’t say there was anything specific that they were against, the scheme in general has received support from the public because they appreciate what we are trying to do.
The benefits of the scheme clearly address concerns that even the Kenyan population had before in terms of being able to shield them from catastrophic expenditure when it comes to healthcare.
The only modification that was highlighted was the requirement to have a marriage certificate before you are registered together with somebody as your spouse.
It became apparent to us that a lot of Kenyan families out there don’t have the documents such as marriage certificate itself.
After a lot of feedback we agreed we are going to modify that to say proof of marriage which might depend; some people might come with affidavits, a letter from the chief, it is not our mandate to decide but that is vested within other bodies in government.
Stakeholders gave their views and at the end of the day we have to balance an look at the interests of the wider population and secondly looking at what is good at us in terms of what we want to achieve which is UHC.
How will the issue of polygamy be handled in the new fund?
Polygamy is something that is within our culture and is legally allowed within our Constitution so it is about being able to accommodate how we take care of the increased number of people under that household.
In fact one of the discussions of the scheme was how we define a household so the perspective in the end was that they are regarded as one household because we are not going to spilt up the families, but the contributions are going to be paid on the income of that family.
If you got a household that is larger, if it has got multiple sources of income we will aggregate those sources of income and that is the basis which determines which premium will be paid so it is not that we are targeting anybody specifically.
What we are saying is the same principle applies even if it is a monogamous marriage. If we are talking about a household and the income especially those from non salaried employment we just put the two incomes together and use that to compute the premium.
So in a polygamous set up it is the same, we put the incomes of all the people who are earning within that household, aggregate them and that becomes the household income.
Is the concern by health unions that the new fund will not cater for them comprehensively like NHIF valid?
I would say it is a justified concern but it is not a discussion that needs to be held with Social Health Authority.
It is discussion that should be held between the employer and the unions because if you look at the genesis of the so called comprehensive schemes, they were enhanced schemes which the employers decided to give an additional benefit to their employees. The mere fact that that landed at NHIF was purely because NHIF was operating at that time as an insurance company.
At the moment the law does not allows the SHA to manage any enhanced schemes so even if we were willing to do it we cant.
We re legally bound by the law and therefore it is not something that we are going to take on at this point. What I would suggest is that the unions go and have discussions with their employers and look for alternative people who can provide top up in the insurance in the event they feel that the package that is going to be offered by the SHA is not going to be comprehensive enough.
But in my view the package being offered by SHA if it comes into fruition and if we we are able to access the resources that we want is comprehensive enough so I don’t think there is any significant reason for concern.
What is your message to Kenyans who are still skeptical as a result of the NHIF shadows?
The Social Health Authority came into being as a solution to the problems that NHIF had. Secondly it is a new body, so we are not going to take a lot of the baggage coming from NHIF.
In general if you have a large organisation with 1,700 to 2,000 people naturally in distribution you are going to have 50 horrible employees. So at the end of the day NHIF has been given a bad name by some very bad employees, first of all those employees will not be onboard to SHA.
Secondly we are going to reorganize our organizational structure to make sure it is fine tuned to the current needs and thirdly we are going to leverage on technology to the extent that we make our system more efficient and more accountable.
In terms of fraud, that has to be dealt with. The legislation will ensure there are significant penalties in terms of anybody who engages in fraud, we are going to put in place measures to ensure that even if people attempt to engage in fraud they don’t get paid, I keep saying the deterrent to fraud is to make sure they don’t benefit from it.
Thirdly there are going to be consequences, that is what has not been there in the past. There ought to be legal consequences where people engage in fraud are held to account and the funds are recovered.
What next after the court suspended Section 26(5) of the Social Health Insurance Act which makes registration and contribution a precondition for dealing with or accessing public services?
The intention was not to deny people government services, the intention is to make sure that everybody enrolls with the social health insurance scheme. In the absence of everybody enrolling in the scheme it doesn’t work.
What has happened in the past is when someone anticipates the need to benefit from NHIF is when they pay premiums and after they have benefitted they opt out.
For example, if someone pays contributions worth Sh1,500 and then goes and accesses services worth Sh200,000 and subsequently doesn’t pay a single coin it is not sustainable and it is extremely unfair because we need everybody contributing those smaller amounts to have this large pool so that those who are unwell can benefit.
This aspect of adverse selection where you have people who are paying when they only feel they want to benefit is what we are trying to kill and especially among the people whose income is not from salaried employment so the reason why we had section 26(5) was to make sure that anybody who ideally should be able to pay should pay.
In the absence of us having a way to enforce that my fear is that we might not be able to rise the financial projections that we require because we will go back to the same problem. Remember 80 per cent of the population is in informal employment so if we lock them out the social health insurance aspect will clearly not work.
Parting shot
The problems we had in our healthcare system were clear, the solutions have been crafted to solve these problems, the ideas that we have and the concept is conceptually sound and everything ideologically aligned to UHC. In addition to that, the team we have as a board and the team we intent to set up as SHA is going to execute and deliver.