Introduction

The World Health Organisation (WHO) defines Universal Health Coverage (UHC) to mean that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. It covers the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.

President Ruto is determined to make UHC a success, given its failed attempts in the former regime. Improving healthcare is among the five pillars of the Kenya Kwanza Manifesto, with healthcare being among the government’s five key pillars. The manifesto outlines commitment to healthcare reforms, which includes delivering a Universal Health Coverage (UHC) system built on three pillars, namely:

1.     Publicly financed primary healthcare (preventive, promotive, outpatient & basic diagnostic services), that gives patients choice between public, faith based and private providers, based on a regulated tariff.
2.     Universal seamless health insurance system comprising mandatory national insurance (NHIF) and private insurance as complementary covers,
3.     National fund for chronic and catastrophic illness and injury costs not covered by insurance to be funded by a combination of insurance levy and Government.

President Ruto’s strategy for achieving this commitment includes institutional and policy reforms. Institutions such as KEMSA, for instance, had several administrative changes where early in the year, President Ruto fired the entire KEMSA board and suspended the CEO over tender irregularities that saw Global Fund cancel tender procurement of mosquito nets meant for low-income families.

In addition, President Ruto proposed policy reforms in the health sector, including repealing the National Health Insurance Fund (NHIF) Act and replacing it with the proposed Social Health Insurance Fund (SHIF) Bill currently in the National Assembly.  SHIF seeks to realign healthcare systems, enhance pooling of resources and risks based on principles of solidarity, equity and efficiency, and promote strategic purchasing of healthcare services.

Primary Healthcare Bill

In addition to SHIF, the President introduced the Primary Healthcare Bill in the Senate. The Primary Healthcare Bill seeks to establish primary healthcare networks at the community level. Healthcare services in the community are two-pronged: the community level, which is accessible at the households and facility health services accessible at the health facilities.

At the household level, the community health promoter (CHP) shall be in charge of 100 households in the communities across the country and shall be equipped with modern medical equipment. The CHP shall be responsible for sensitising the community on the importance of healthy lifestyles and monitoring the health status of members of the households assigned, among other functions. The CHP shall also be responsible for making referrals to the link health facility.  

Social Health Insurance Fund (SHIF) Bill

SHIF seeks to establish the Social Health Authority, which shall include contracting and making payments to healthcare providers and facilities out of the 3 Funds established. These Funds include the Primary Healthcare Fund, Social Health Insurance Fund (SHIF) and the Emergency Chronic and Critical Illness Fund.

Primary Healthcare Fund

The purpose of the Primary Healthcare Fund shall be to purchase primary healthcare services from health facilities. The National Assembly shall appropriate the capital of the Fund.

Social Health Insurance Fund Contributions

Every Kenyan shall be registered as a member of the SHIF. SHIF shall consist of funds from:

1. Appropriations by the National Assembly for indigent and vulnerable persons;
2. National and county governments for the administration of compulsory public service employee insurance benefit scheme; and
3. Any other employer.

Contributions to the SHIF shall vary among different Kenyan households, i.e., salaried, non-salaried and those in need of financial assistance. The contribution variation shall entail:

1.     Salaried households who shall contribute monthly.
2.     Non-salaried households who shall contribute annually in accordance to a proportion of household income determined by means testing instrument (MTI) which contains a set of indicators that capture various socio-economic aspects of a household to determine the ability to pay social health insurance premium.
3.     In case of households in need of financial assistance as determined by the MTI, by the government at a rate from the appropriated funds by Parliament and County Assemblies.
4.     In case of persons under lawful custody by the government at a rate from the appropriated funds by Parliament.

The Bill proposes to impose a penalty to any person who fails to pay any contribution to an amount equal to 10% of the amount due for contribution, which the National Assembly lowered to 2% as the members felt it was quite punitive.

Emergency Chronic and Critical Illness Fund

The Emergency Chronic and Critical Illness Fund shall be used to defray the costs of managing chronic illnesses after depletion of the SHIF and to cover emergency treatment costs. The National Assembly shall appropriate money to this Emergency Chronic and Critical Illness Fund.

Conclusion

UHC is critical in protecting people from the financial consequences of paying for health services out of their own pockets, hence reducing the risk of pushing people into poverty. The three Funds created under the SHIF Bill will supplement each other by noting that the Emergency Fund is used to access healthcare services where the SHIF has been depleted.

The Primary Healthcare Bill and the SHIF Bill, if passed by both Houses of Parliament, will align with WHO’s recommendation on reforming health systems using a primary healthcare approach, which ensures access to healthcare services to the community level and provision of quality services, hence improving coverage and financial protection.

Systems are in place to ensure the launch of UHC by President Ruto on 20th October, 2023. The President recently flagged off 100,000 CHPs. KEMSA also announced that it had stocked kits to be used by the CHPs to detect health issues at the community level early. International funding organisations, such as the Global Fund, have also announced support to the government’s UHC agenda through technical assistance to KEMSA, whereas USAID has pledged to offer its technical expertise support to the CHPs.

The success of the UHC will not only be the government’s achievement in attaining its manifesto’s commitment to healthcare reforms but a step forward in achieving UHC, which is one of the targets for UN sustainable development goals.