From the manifesto, Kenya Kwanza emphasised its commitment to realise the constitutional right to health in the shortest time possible by delivering a Universal Health Coverage (UHC) system. This was meant to be built on three pillars. The first pillar is a fully publicly financed primary healthcare system (preventive, promotive, outpatient and basic diagnostic services), that gives patients a choice between public, faith-based and private providers, based on regulated tariffs. Secondly, a  seamless universal health insurance system comprising mandatory national insurance (NHIF)and private insurance as complimentary covers, with NHIF as the primary and private insurance as the secondary cover. Finally, a national fund for chronic and catastrophic illnesses and injury costs not covered (or with very restrictive cover) by insurance (cancer, diabetes, strokes & accident rehabilitation, pandemics) to be a funded combination of insurance levy and the government.

To this end, the President stated during the inauguration of the Kenya Health Human Resource Advisory Council that in order to realise the ambition of affordable and quality Universal Health Coverage, Kenyans will contribute 2.75% of their gross salary towards the National Health Insurance Fund (NHIF).  

The National Health Insurance Fund Regulations, 2023 stipulates that a contributor in salaried employment, a self-employed person shall pay a standard contribution at a rate of 2.75% of the gross monthly income derived from employment in the preceding month. This position was reaffirmed by Mr Michael Kamau, the NHIF chairperson during an interview.

He defended the rationale behind the decision to raise NHIF contributions by explaining that the 2.75% rate is a way of promoting a sense of equity through a social insurance scheme.  Despite the disparity in individual earnings, he asserted that there had never been equity in how people contributed to the insurance fund.

In the interview, Mr Kamau noted that there is a need to level the playing field since low-income individuals have borne the brunt of NHIF contributions. He argued that the proposed average rate of 2.75 percent for NHIF contributions should not be viewed as an increase. He explained that individuals earning Ksh. 100,000 and above would pay Ksh. 1,700, which was the same amount already being paid by the 385,000 individuals in the NHIF database. Consequently, these premiums accounted for an average of 1.12 percent of their salary.

This structure somehow burdened the low-income earners hence the need to create equity through a percentage.

Mr Kamau stated that “the only way to create equity is to bring in a percentage. The 2.75% is brought by the average of all the total receipts, which is 2.5%. This will reduce the contribution made by the people earning Kshs. 35,000.”

He further explained how the new NHIF Scheme would work. For unemployed people, the chairperson stated that the National Government on behalf of indigent and vulnerable persons would contribute Kshs. 500 on behalf of the indigents that have been identified by the county government. However, the NHIF Regulations stipulate Kshs. 13,300 to be the amount payable by the National Government on behalf of indigent and vulnerable persons. Mr. Kamau in defending his assertion emphasized that the contribution shall be Kshs. 500 and not Kshs. 13,300 as stipulated in the Regulations.

Further, it was indicated that those in the informal sector who previously contributed Kshs. 500 would now pay a minimum of Kshs. 300 which is in contradiction to the National Health Insurance Fund Regulations, 2023 that highlights that a contributor who is not employed or listed as an indigent person or vulnerable person shall pay a monthly contribution of Kshs. 1,000.00. Mr Kamau defended the minimum of Kshs. 300 noting that after considering the public participation views the amount has been reduced meaning that those in the informal sector will enjoy a drop of 40% commencing 1st July upon the regulation coming to pass.

From the chairperson’s analysis, NHIF will experience a reduction of contribution since out of the four million households that remit the NHIF premiums, the number of contributors will drop to 2.7 million after the move from individual contribution to household contribution scheme. A household would have one person contribute on behalf of the household which would be a drop of 1.3 million contributors. This proposed contribution structure  to change the contribution to family/household rather than individual as is the case with private insurance will promote equity.

In the quest to actualize the Universal Health Coverage agenda, the new proposed 2.75 per cent of gross monthly income to the health scheme will see increased resources for the healthcare sector. This calls for the development of a proper legal framework and enhanced service delivery that will enable NHIF to achieve its mandate and win the trust of contributors.

The NHIF will need to ensure that there is value addition by ensuring there is a proper organisation. This will entail the digitization of services to improve their service delivery. The institution should also leverage the auto-adjudication system to review, calculate, and process medical claims with zero to minimal human interference.  

Achieving equity in health insurance is not based on the contributions made to the NHIF only but on the whole spectrum. Kenya Kwanza observed that NHIF still falls far short of the social health insurance scheme that it ought to be both in terms of its design as well as operational performance.  As Kenya Kwanza strives to implement the relevant reforms required so as to build trust in NHIF, the mess at NHIF ought to be dealt with, and measures to ensure proper management of the funds should be put in place.

With the inception of the  National Health Insurance Fund Regulations, 2023, the President and the board chair are optimistic that the contentious healthcare program will change for the better and shed its reputation as a sick, dishonest, and uninteresting institution, corrupt and controversy-ridden NHIF. With the idea of pooling resources through NHIF to ensure everyone is able to access affordable healthcare, Kenya Kwanza needs to do more to its commitment to actualize the UHC system.