By Anyang' Ny'ong'o
In 1989, the National Hospital Insurance Fund (NHIF) fixed rates paid by contributors at Sh30 per month for the lowest contributor and Sh320 for the highest contributor.
In other words the gardener who works for me pays Sh30 and I pay Sh320 every month. When any of us falls sick and is admitted to hospital, the NHIF will cover part of our bill and not all.
Our contributions are too low to make it possible for the NHIF to cover the bulk of our in-patient medical care in present day Kenya.
Over the last 20 years, NHIF board members, where Central Organisation of Trade Unions (Cotu) is aptly represented, have been touring many countries to look into how social health insurance is run.
From these trips, numerous reports have been written and discussed every year and lots of recommendations made.
Going through all the reports and recommendations, there are two constant issues: one, that the current rates of contributions are too low, they need to be revised to keep up with inflation, purchasing power parity and the real cost of health care; two, that the NHIF should implement a Universal Health Coverage Scheme (UHC).
In 2008 we decided to finally implement these recommendations and put a stop to trips, studies and reports.
We, therefore, hired the International Finance Corporation (IFC) to undertake a Strategic Management Review to find out why and how the rates should be revised and UHC implemented.
We also sought to know what management and structural reforms were necessary to ensure that NHIF delivers on its mandate competently, cost effectively and efficiently.
The report is robust and provides a clear roadmap for the NHIF to deliver on its mandate.
IFC consulted all stakeholders, including Cotu. When the report was out we discussed it at a stakeholders workshop at the Panafric Hotel where Cotu was represented.
The workshop resolved that the move towards universal health coverage was laudable and should be implemented.
It was observed that the pilot study that had been carried out on outpatient coverage needed to be fully cascaded as universal health coverage is implemented.
It was, therefore, appropriate that NHIF seeks to overcome all hurdles in implementing the Civil Service and Disciplined Forces insurance scheme as this was well within its (NHIF) mandate and was a good precursor for UHC.
Indeed both court cases that Cotu filed and lost against the new rates have emphasised the need for the NHIF to deliver on its mandate in public interest.
The IFC has crowned this by very clear recommendations worthy the attention of all stakeholders.
The NHIF was the vision of the founding fathers of this nation. It was launched in 1966. Other nations in the East African region eventually followed in the footsteps of Kenya, with Rwanda being the latest in 1998.
While the NHIF currently covers only 26 per cent of Kenyans, the young Rwandan nation gives in-patient and outpatient coverage to 92 per cent.
The contribution per month ranges from 5 to 30 dollars per month depending on one’s income. That works out to about between Sh300 to Sh2, 400 in Kenya.
I have just come from a three-day East African Health Protection conference in Kigali, Rwanda, attended by all the Health ministers in charge of health financing in the Community countries.
We resolved, among other things, to implement Universal Health Coverage in each member state as the surest way of achieving MDGs and middle-income status for our economies by 2030.
At a purely rational level it is difficult to understand why anyone should oppose steps taken by the NHIF to deliver better health coverage to Kenyans.
But then important issues are not always looked into by political stars from rational points of view. The irrationality of politics, especially when it vies towards the pathological, always interferes.
I have heard it said in certain quotas that as long as I remain the minister under whose charge the NHIF falls, certain people will do all it takes to frustrate any positive gains at the Insurance Fund.
But as the popular saying goes, when the elephants fight it is the grass that suffers.
The Ugandan poet, Okot p’Bitek, puts it very well in his epic poem, Song of Lawino:
While the pythons of sickness swallow the children;
And the buffalos of poverty knock the people down;
And ignorance stands there like an elephant.
The wars leaders are busy
Eating each other’s liver!
We can grandstand while fighting against our political opponents and resist ideas, which could help our people.
But then “we” who do this have never been in a position where the lack of a single shilling to pay for medicine can be life threatening.
If UHC is not a rescue to people under such circumstances, then I need to be informed of a better alternative.
The writer is Minister for Medical Services and ODM Secretary General