President William Ruto plans to initiate more cuts on salaried Kenyans’ pay yet again, this time round to help realise Universal Health Coverage.

The draft Social Health Insurance Bill, 2023, has proposed deductions of up to of 2.75 per cent of gross pay from each employee, monies to be channeled towards the new Social Health Insurance Fund (SHIF).

This means that the lowest earner will have Sh300 deducted from their salaries every month with no maximum contribution.

“The government shall ensure that premium financing products are provided for non-salaried persons for the payment of social health insurance,” the Bill reads in part.

The Bill which is set to be presented in Parliament once MPs resume sittings from recess will see NHIF transition to SHIF.

SHIF will be used for preventive and promotive and primary care services at community, dispensary and health centre levels and build a chronic illness and emergency fund that provides for chronic illnesses.

A Social Health Authority (SHA), Afya Bora Fund and the Chronic and Critical Illness Emergency Fund (CCIEF) are also proposed for establishment.

Cabinet has approved the Bills which include the Primary Health Care Bill, 2023, Digital Health Bill, 2023 and Facility Improvement Financing Bill, 2023.

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The Facility Improvement Financing Bill among others dictates the placement of health facilities and the funding it requires.

It will be compulsory for all Kenyans to be members for them to enjoy government’s health services.

Speaking recently in Vihiga, President William Ruto announced that the government would change the funding system to allow vulnerable groups in the country to access the National Health Insurance Fund (NHIF).

“We are changing the funding system so that we can allow the vulnerable to access NHIF free of charge and those who are in the lower category to pay less, those who earn more to pay more,” Ruto said.

He stated that the move would stop making healthcare in the country a privilege of a few people who can afford it and make it a right of everyone who requires medical care.

Each beneficiary, the Bill states, will be entitled to an essential healthcare benefits package to be prescribed by a health cabinet secretary in consultation with the board.

“The authority shall make payments out of the Funds to health care providers or health care facilities that are empaneled and contracted in accordance with the provisions of this Act,” it reads.

It adds, “A health care provider or healthcare facility seeking to be empaneled under the Act shall make an application to the body responsible for accreditation for quality of care in the manner prescribed by the CS.”

Health Cabinet Secretary Susan Nakhumicha has said the government will co-opt legislators as champions of UHC in their regions.

“We want the MPs to help us take the message out so that we can have clarity of what it is that we need to do as a government,” she said.

She echoed the President’s message that the Kenya Kwanza administration is “committed to ensuring the UHC works this time round”.

The level of service assessment which is currently being undertaken by a team of experts, the CS noted, will inform on the existing gaps on human resource, infrastructure and equipment.

“The unique thing that we are going to do after this process is that we are going to map health facilities into a primary care network and these facilities are not just public, we have private and faith-based facilities so that we should be able to direct patients to where services are available,” she said.

The government-sponsored medical cover for public secondary school students risks collapse due to funding and logistical challenges, a parliamentary report shows.

“There have been challenges in the enrolment of students to the National Education Management System (Nemis), from which Edu-Afya gets its data.”

“This is brought about by lack of internet technology, lack of birth certificates for some students and low motivation by school heads to register their students to Nemis. This has caused delays in use of the scheme as well as lower numbers of students enrolled as projected when starting,” the brief reads in part.

The success of the Edu-Afya programme, an initiative of former President Uhuru Kenyatta, is un-der threat due to poor coordination and lack of clear structures to guide its operations. A brief prepared by the Parliamentary Research Services and seen by Nation shows that the terms and conditions of the scheme for the period between 2018 and 2022 are missing, a fact that threatens the success of the initiative.

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Launched in 2017 through a presidential order, the initiative has led to an increase in health budgetary allocations to the tune of Sh4 billion annually based on a premium of Sh1,350 per student per year. The Kenya Secondary School Heads Association has claimed that over 800,000 students are yet to benefit from the initiative due to logistical challenges, which have locked out many students especially those in the rural areas.

The six page brief prepared to guide the Public Petitions Committee on a plea by Joyce Cherono for MPs to intervene and save the programme says uptake of the cover is still low due to poor communication, awareness and challenges in reimbursements of funds as they would receive partial payments without remedy to address remaining balances due to the missing Nemis numbers.

There have been challenges in the enrolment of students to the National Education Management System, from which Edu-Afya gets its data.

“They would be treated and payment sorted out later. Most of these manual claims have not been paid since NHIF only accepts claims made through the Edu Afya management information system,” reads the brief.

In a bid to make the initiative effective, the parliamentary team recommends that NHIF needs to clarify the terms and conditions of the scheme as it did for the Lin-da Mama scheme.

“There is a need for procedural clarity in the management of the scheme so as to reduce procedural delays for participating providers. Terms and conditions were missing in contracts covering the period 2018-2022.This needs to be corrected and can be clarified further by development of a hand-book on Edu Afya by the NHIF as done in other schemes, reads the brief. NHIF has also been directed to conduct training and sensitisation in public secondary schools targeting students, teachers and parents about the programme.

“The Ministry of Education and NHIF should liaise with stake-holders in accrediting more health facilities,” says the brief.

The parliamentary team has al-so called on the Ministry of Edu-cation to revise its policy on the programme in order to include the role of school principals in ensuring effective utilisation of the fund.

Further, the team has recommended that the procedure and system of enlisting students into NHIF should be simplified to encourage utilisation of the scheme. The Ministry of Education and NHIF signed a contract in 2018 and students started accessing services from May 2018.

In order for one to access services, the beneficiary is required to present an NHIF membership card or a stamped letter from the school’s principal or a designated official if the student is yet to receive a membership card.

Benefits include outpatient, inpatient, surgical, ambulance and emergency air rescue services.

Optical and dental services are, however, covered only in public facilities as a cost containment measure. The committee is expected to table its report on the future of the initiative on May 17.

High Court in Nairobi has thrown out a case filed by the Kenya Union of Post Primary Education (kuppet),  challenging the appointment of the rival Kenya National Union Of  Teachers (KNUT) to sit on the National Hospital Insurance Fund (NHIF) board.

This decision will be a big blow to Kuppet, which contested the representation of Kenya National Union of Teachers (Knut) in the health insurance agency.

Justice Hedwig Ong’undi stated that it would be in vain to allow Kuppet case and to annul the appointment of Knut’s representative Wycliffe Omucheyi. According to Judge Ong’undi, the NHIF law has already been amended to strike out the two giant teachers’ unions representation to the board. The judge observed that the Omucheyi will be leaving NHIF on May 9.

According to Ong’undi, there was a lacuna in the NHIF law that made it possible for Knut to hoodwink Kuppet. She said that if Kuppet had filed its case before the Judicial Review division of the High Court, the issue would have been resolved much earlier.

“Whatever happened to the petitioner and as a result of which the third respondent (Knut) benefitted is unfortunate. The Law itself had a lacuna and somebody somewhere took advantage of it. Had the petitioner filed a Judicial Review to question the decision-making process the matter may have been sorted out earlier,” said Justice Ong’undi.

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In the case, Kuppet had argued that it had a mutual agreement with Knut that each union would select a representative on alternating intervals. The court heard that the previous term had been held by former Knut chairman Mudzo Nzili.

At the end of it, in 2019, NHIF did not alert Kuppet to nominate its representative. However, Kuppet stated that it forwarded Wicks Mureithi as its nominee, but Omucheyi’s name was gazetted instead.

“The petitioner protested the decision and demanded a revocation of the appointment. The same was not responded to,” Kuppet claimed.

NHIF, Knut and Attorney General opposed the case. In its reply, the insurance fund accused Kuppet of jumping the gun. According to NHIF, the union ought to have exhausted internal dispute resolution mechanisms before approaching the court.

On 16^th April 2020, during his fourth address on the corona virus pandemic, the president directed the Ministries of Public Service and the Treasury to develop a welfare package for government workers. This directive is what yielded the enhanced comprehensive medical cover that was launched on 19^th November 2020. You need to know the following about the enhanced comprehensive medical cover.

• The enhanced comprehensive medical cover will cost Sh6.3 billion and will target all civil servants, including teachers.
• The scheme is an improvised version of the group life expense and last expense benefits, which was previously allocated annual amount of ksh. 839 million. It will also cover enhanced work injury benefits and group personal accident. The group personal accident will be pegged at eight times the gross salary for all job groups, costing ksh. 1.18M while work injury benefits will cost ksh. 1.33 billion

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• All frontline government employees working during Covid-19 pandemic, including National Youth Service (NYS) personnel, will be covered.
• The lead insurer of the enhanced medical cover will be the National Hospital Insurance Fund (NHIF). The scheme has been approved by the cabinet and kSh.3.3 billion of the total sum will cater for the group life, including covid-19.
• The enhanced comprehensive medical cover is pegged at eight times the gross salary of an employee, in each of the job groups A to U, as well as an additional ksh3 million for critical illness. The previous cover ranged from ksh. 700,000 to ksh. 1.7million.
• Any civil servant, including teachers,  and NYS staff who die in service from illnesses will receive eight years’ gross salary while those who die from occupational illness like Covid-19 will receive 16-year’s gross salary.
• Families of Civil servants who die from accidents will be paid 24-years salary by the Group life and Work.
• The last expense cover for the principal will be ksh200,000, from ksh. 100,000 in the previous cover.  The spouse and children’s last expense cover will be ksh100,000.
• Critical diseases like cancer and cardiac problems will be covered for a limit of ksh. 3 million,above the NHIF medical limit.