National Health Insurance: The way forward

By Lukoye Atwoli
Sunday Nation 13 May 2012

The stated intention of the expanded National Hospital Insurance Fund (NHIF) programme was to provide Kenya’s uninsured poor access to health services, partly in fulfilment of the constitutionally guaranteed right to health. Unfortunately, there was little information given about the administration of the scheme, and exactly who it would benefit.

Opposition to the new scheme was based on a number of considerations.

Firstly, it was felt that if the NHIF were allowed to raise the monthly premiums at will, a situation could arise where they would become a major drain on the incomes of Kenyans without serious oversight from the contributors’ representatives or parliament. Arguments have been advanced that majority of contributors were represented on the NHIF board by various organisations. However, a cursory glance at the board would show that this is not the case. 

It was top-heavy with government functionaries- permanent secretaries, the Director of Medical Services and the government-appointed Chief Executive Officer. Most members of the board were either government appointees or appointees of institutions that derived only indirect mandates from their constituents. Out of fourteen members (including the CEO) eight were directly appointed either by the president or the minister in charge of health. 

Secondly, the expanded scheme was opposed due to the knowledge that the selected facilities lacked the capacity to administer the scheme. As early as January this year, it was clear that the clinics that were being allocated funds by NHIF to take care of civil servants (who were similarly allocated to the clinics!) were either non-existent in many parts of the country, or lacked facilities to carry out their mandate. Despite flagging the issues four months ago, they were ignored until a few days ago when everyone started acting as if the problem had just been noticed.

Finally, the ability of NHIF to manage the huge amounts of money that would be collected from contributors was in doubt. NHIF has been audited in the past and found to be a wasteful insurer that uses an inordinately large amount of money in administration, with a smaller percentage used to provide care for contributors. Indeed, evidence of the expanded inefficiency came in claims that workers at NHIF had been promised huge salary increments as soon as the new rates were operational.

Given that we all acknowledge that the government has a constitutional responsibility to provide healthcare to all citizens, one would have thought that the easiest way of doing so would be to legislate for a Health Fund. This fund would be made up of 15% of government expenditure (as passed in the Abuja Declaration), as well any other monies collected for the purpose, such as a specific Health Tax on income, taxes on harmful consumables such as alcohol, tobacco and even confectioneries.

The fund would then be used to build, equip and staff health facilities within reach of all Kenyans, and to also provide for promotive, preventive and rehabilitative health care. A law could then be passed requiring all employed persons to have health insurance of their choice, with the default insurer for those who may be either unable or unwilling to get commercial insurance being the NHIF.

With parliamentary and public oversight, this system would be easier to manage and more acceptable than the opaque behemoth that was trying to steal from us in broad daylight!

Dr Lukoye Atwoli is the secretary, Kenya Psychiatric Association and a lecturer at the Moi University School of Medicine. Lukoye@gmail.com; Twitter: @LukoyeAtwoli