President Assents to 4 Universal Health Coverage Bills, Restructuring NHIF

In honor of the pledge to accelerate Kenya’s attainment of Universal Health Coverage (#UniversalHealthCoverage), President William Samoei Ruto signed four crucial bills promoting healthcare on October 19, 2023. These are:

1. The Primary HealthCare Bill, 2023
2. The Digital Health Bill, 2023
3. The Facility Improvement Financing Bill, 2023
4. The Social Health Insurance Bill, 2023

Transformative Changes

These four bills usher in a paradigm shift in Kenya’s healthcare legal and institutional framework by repealing the current NHIF and establishing three new funds:

• Primary Healthcare Fund (PHF)
• Social Health Insurance Fund (SHIF)
• Emergency, Chronic, and Critical Illness Fund (ECCIF)

The NHIF has recorded a steady decline in fulfilling its mandate recently. The Kenya Association of Private Hospitals (KAPH) had even banned the use of the NHIF card due to non-payment by the insurer. This situation has caused anguish for many Kenyans, as NHIF is the most popular health insurance in the country and is heavily relied upon. Patients have had to pay in cash or remain untreated. Public hospitals still accept the NHIF card for payment, but the insurer covers only limited services, prompting patients to seek assistance from private hospitals.

The President’s move to assent to the four Universal Health Coverage Bills, which repeal the current NHIF, has elicited mixed reactions as discussed in our newsletter.

Important Highlights

Section 26 of the Social Health Insurance Act, 2023 makes it mandatory for every Kenyan citizen to register as a member of the Social Health Insurance Fund. The Emergency, Chronic, and Critical Illness Fund will cover emergency and chronic illness costs once the Social Health Insurance Fund is depleted.

The Primary Healthcare Act, 2023

Section 2 of the Primary Healthcare Act defines Universal Health Coverage as ensuring “all individuals and communities receive the health services they need, including the full spectrum of essential, quality health services from health promotion to prevention, treatment, rehabilitation, and palliative care without suffering financial hardship.”

The Act further defines Primary HealthCare as “essential health care based on practical, scientifically sound, and socially acceptable methods and technology, made universally accessible to individuals and families in the community at every stage of their development, through their full participation and at an affordable cost to the community and country, in the spirit of self-reliance and self-determination.”

Its main objective is to promote and fulfill Article 43(1) of the Constitution of Kenya, 2010, which provides for every person’s right to the highest attainable standards of health care. Other objectives under Section 3 include:

• Implementing primary health care through a systemic approach and clear delineation of roles of all stakeholders towards the realization of universal health coverage
• Establishing Primary Health Care Networks, Community Health Units, and other stakeholder-centered engagement forums for sustainable primary healthcare services
• Providing for the role of the multidisciplinary team in the provision of primary health care services
• Providing for the role of community health officers, community health assistants, and community health promoters in providing community-based primary health care services

Digital Health Act, 2023

The Digital Health Act streamlines the adoption of technology to facilitate data sharing and resource utilization.

Section 3 outlines its objectives to ensure and promote Universal Health Coverage, including:

• Establishing the Digital Health Agency
• Maintaining a comprehensive integrated health information system
• Promoting innovation and the safe, efficient, and effective use of technology for healthcare, including continuity of care, emergency and disaster preparedness, and disease surveillance
• Establishing a regulatory framework for the e-Health ecosystem data life cycle
• Ensuring privacy, confidentiality, and security of health data
• Developing standards for the provision of m-Health, telemedicine, and e-learning
• Establishing a regulatory framework for e-Waste Management
• Ensuring the safe and secure transfer of personal, identifiable health data and client medical records to and from health facilities outside Kenya

Social Health Insurance Act, 2023

The Social Health Act does away with the NHIF by introducing three new funds: Primary Healthcare Fund, Social Health Insurance Fund, and Emergency, Chronic, and Critical Illness Fund.

Section 26 makes it mandatory for every Kenyan citizen to register as a member of the Social Health Insurance Fund. The Primary Healthcare Fund will enable Kenyans to purchase health services from level one to three hospitals, while the Social Health Insurance Fund will cover services from level four to six hospitals. The Emergency, Chronic, and Critical Illness Fund will cover emergency and chronic illness costs once the Social Health Insurance Fund is depleted.

The main objective, as outlined under Section 3, is to establish a framework for improved health outcomes and financial protection in accordance with the right to the highest standards of healthcare and Universal Health Coverage.

Facilities Improvement Financing Act, 2023

Section 4 provides that the Act applies to level one to level five public health facilities.

Objectives under Section 3 include:

• Enabling the collection, retention, and management of revenue derived from health services offered at public health facilities in Kenya
• Establishing a governance framework for effective planning, coordination, mobilization, and access to public facilities’ improvement financing
• Appropriating, managing, and using budgeted health services revenue to supplement operations and facilitate quality service delivery in public health facilities
• Promoting equitable public health facilities improvement financing, including benefit sharing
• Providing a unified system for financial management in public health facilities, improving efficiency and effectiveness, and promoting quality health service delivery

Response and Reactions from Kenyans

The President’s assent to the new legislation has not been well received by some Kenyans, primarily due to concerns about the high cost to salaried workers. The Standard newspaper highlighted this concern on October 23, 2023. However, Health Cabinet Secretary Susan Nakhumicha assured citizens on October 25, 2023, that a regulatory body will determine the premiums and oversee the implementation of the Universal Health Coverage Act. The transition from NHIF to the Social Health Authority will take 12 months.

Conclusion

We hope this information is helpful in understanding the current developments regarding the repeal of the National Health Insurance Fund and the establishment of the Primary Healthcare Fund, Social Health Insurance Fund, and Emergency, Chronic, and Critical Illness Fund. Please note that this newsletter provides a general guide and should not be relied upon without legal advice.

For further information or legal assistance, contact us at info@wka.co.ke, visit www.wka.co.ke, or call +254 798 03 580. Our Nairobi Hub is located at Parklands, Valley View Business Park, 6th Floor, City Park Drive, Off Limuru Road.

Authors:

• William Karoki, Founding Partner
• Florence Mwende, Lawyer