The National Health Insurance Fund (NHIF) will be dismantled to pave the way for three funds that will be managed and administered separately for efficiency.

On Tuesday, the Cabinet approved the proposal to scrap NHIF to create the Primary Healthcare Fund, Social Health Insurance Fund, and the Emergency, Chronic and Critical Illness Fund.

Last year, during the run-up to the presidential election, President William Ruto promised the delivery of UHC, as set out within the government’s plan for a healthier nation espoused under the Kenya Kwanza Bottom-Up Economic Transformation Agenda (BETA). 

“Cabinet considered and approved crucial Bills that promote healthcare for transmission to Parliament, as follows: The Primary Health Care Bill, 2023; The Digital Health Bill, 2023; The Facility Improvement Financing Bill, 2023; and The Social Health Insurance Bill, 2023. These Bills usher in a paradigm in the legal and institutional framework for healthcare in Kenya by repealing the current National Health Insurance Fund and establishing in its place the following funds: Primary Healthcare Fund; Social Health Insurance Fund; and Emergency, Chronic and Critical Illness Fund,” the despatch from Cabinet indicated.

According to State House Spokesperson Hussein Mohamed, the three funds emerge from the reorganisation of pre-existing funds, that is, the reorganisation of the Ksh550 billion that constitutes the country’s total health expenditure, to achieve Universal Health Coverage (UHC). “The Primary Care Fund will be funded from the Exchequer,” he stated. 

The Social Health Insurance Bill, 2023

During the presidential campaigns, the Kenya Kwanza manifesto committed to providing social health insurance coverage for all Kenyans with no exclusions, in the policy of “leaving no one behind”. During the campaigns, President Ruto committed to setting up the Emergency Medical Treatment Fund to cater for emergencies, cancer treatment and referrals, and to set aside funds for strategic programmes and retirees.

The government says this commitment will be actualised by the Social Health Insurance Bill, 2023, which establishes the authority that shall replace NHIF. The bill has established the three funds to cater for preventive and promotive primary care services at the community, dispensary, and health centre levels.  

A Social Health Insurance Fund that shall cover services such as primary referrals, secondary and tertiary services; and A Chronic Illness and Emergency Fund that provides for chronic illnesses including complications of diabetes, hypertension, cancer management, and emergency treatment, as enshrined in Article 43(2) of the Constitution which states that a person shall not be denied emergency medical treatment. 

These funds are to be managed by a single board and secretariat, based on the proposed 2.75 per cent deductions on household income from both formal and informal sectors. 

The Primary Healthcare Bill, 2023

The commitment in the Kenya Kwanza manifesto was to employ and initiate payments for community health promoters and integrate preventive and promotive services.

The Primary Health Care Bill 2023 establishes a framework for the delivery of access to and management of primary healthcare. It establishes a framework for the 100,000 community health promoters to be commissioned by President Ruto later in October and outlines the services they will offer when they visit households.

The bill provides for the re-organisation of service delivery at the Primary Health Care levels, including dispensaries and health centres, where the government shall cater for these services. This implies that Kenyans seeking services at these levels will be able to get services without incurring any bills. 

The Digital Health Bill, 2023

During the campaigns, there were promises of an integrated information communication and technology system to enhance telemedicine and health management information systems. The Digital Health Bill 2023 provides a framework for digital health services, data governance, protection of personal health information, and service delivery through digital health interventions. 

The Facility Improvement Financing Bill, 2023

There was also a promise to allocate dedicated funds for healthcare. According to the government, this will be realised through the Facility Improvement Financing Bill 2023, which aims to ring-fence money generated in health facilities, ensuring a predictable, regular, and steady source of funding for health facility operations in the counties. 

Universal Health Care

In June, President Ruto said the government was committed to the successful delivery of Universal Health Care. He said the government would prioritise preventive healthcare, anchored on community health workers, NHIF reform, and provision of medical supplies and equipment to deliver UHC. 

“There have been two failed attempts to implement universal healthcare. But this time round, we are determined to achieve it successfully. Preventive care will make it possible to deal with health issues early at the community level, which will ease crowding at hospitals,” the President said. 

The UHC programme began in 2018 as a pilot programme in four counties. The four were chosen because of high incidences of communicable diseases, non-communicable diseases, maternal and child deaths as well as road accident-related injuries.

The UHC model adopted a two-phase medium-term approach. The first phase was expected to abolish all user fees at the primary level (local health centres) and the secondary level (county referrals) hospitals. The second phase was to be the rollout of a social health insurance scheme through the NHIF. 

In the second phase, contributions were to be mandatory for all Kenyans above the age of 18 years while the government would complement the scheme by paying for the poor.

By 2020, the programme had enlisted more than 200 community health units, with 7,700 community health volunteers and over 700 health workers. Between 2018 and 2019, the project supported 3.2 million Kenyans to access critical healthcare services.

Political leadership 

African countries have been working toward achieving UHC for the past 20 years. In 2001, the African Union (AU) countries met in Abuja and committed to allocating at least 15 per cent of their annual budget to sustainable health financing.

Since then, various African governments have reiterated their commitments to strive for the equitable health of their populations and achieve UHC, working across sectors to make this promise a reality.