Millions of poor Kenyans are set to benefit from a subsidised health insurance cover from October after the government makes a decision on how to fund the programme.
Run by the National Hospital Insurance Fund (NHIF), the cover which has for years sparked controversy, will either be funded by the exchequer or by increased contributions by the existing members, under the Health Insurance Subsidy Programme (HISP).
“The new scheme seeks to enable the poor people to have a healthcare insurance cover under a universal scheme,” said Chacha Marwa, adding that the fund was certain to overcome the opposition that the proposed scheme has faced in previous attempt to implement it.
The planned cover will replace the default National Social Health Insurance Scheme, whose provisions have been opposed by among others stakeholders, the workers umbrella body; Central Organisation of Trade Unions (Cotu).
“NHIF wants to use an evidence-based approach in implementing the new programme which involves understanding how the poor people meet their medical expenses,” said Mr Marwa. In the proposed scheme, NHIF will making another attempt to provide universal health insurance for the entire population after two previous attempts met stiff resistance. In 2004, President Kibaki declined to assent into law the National Social Health Insurance Fund Bill sponsored by the then Health minister Charity Ngilu even after Parliament passed it. The President cited the huge cost that the new legislation would have on the State finances.
The ‘Ngilu Bill’ had proposed that the government pay Sh11 billion to NHIF annually to meet the insurance costs for the poor.
Later in 2010, NHIF proposed to increase the monthly contributions by its members from the Sh320 — payable monthly for workers in the formal sector—on a graduated scale. That would have seen workers earning more than Sh100,000 make a monthly contribution of Sh2000. The lowest contributor would be required to pay Sh150 for those earning a monthly salary of Sh6, 000 and below.
Further, it was envisaged that the government would contribute about Sh5 billion for the 6.5 million Kenyans considered to be living in abject poverty. Amidst this, Cotu moved to court to challenge the proposal terming it unlawful. The matter is still pending in court placing NHIF’s intentions in limbo.
Already the state-sponsored health insurance cover provider has called on consultants to help in the design and implementation of the new subsidy program, which will involve a study to determine the number and distribution of people who qualify for subsidies.
The study, to be funded by the Rockefeller Foundation, will help in justifying to all stakeholders on the amount of funds required and how the services will eventually reach the targeted beneficiaries.
But Gerishon Ikiara, an economics professor at the University of Nairobi says the implementation of such a scheme is highly unlikely to be successful because the probable modes of funding would either be resisted or be too expensive for the economy to support.
“Having a universal health insurance cover is a noble cause but the working population will likely resist paying a higher contribution to cover the unemployed,” said Mr Ikiara, who termed a social health insurance as a tall order in Kenya.
“It has been resisted in the US for very long because naturally people do not want to live in controlled environments including the quality of healthcare one can access,” he added.
The economist said the high unemployment and poverty rates in Kenya means an insurmountable burden on the economy and the working population in trying to provide health insurance for all.
James Nyoro, the managing director at the Rockefeller Foundation expects that having an evidence-based approach would help in raising public confidence in the new scheme and eventually allow even the less-fortunate to enjoy insurance under a universal scheme.
“The study is expected to evaluate cost of providing medical insurance for the poor across the country and this will justify how much each of the poor people would be required to pay,” said Mr Nyoro.
He added that among the issues that led to the resistance of the proposed scheme was failure by the policy makers to involve all the stakeholders—but noted that they plus other professionals would be involved in the design of the new scheme.
“There was not political goodwill and the drafting of the policy was not all inclusive—but we now want to involved everyone in determining how to cross-subsidize health insurance for the poor,” said the Rockefeller MD, in charge of Africa.