Ignore the critics, NHIF scheme is timely

By DOMINIC ODIPO

If there is one issue that all of the major Republican Party presidential candidates in the United States are agreed upon, it is their bitter opposition to what they have all come to popularise and despise as ‘Obamacare’.

Obamacare is of course a derogatory reference to the national health insurance scheme, which President Obama so vigorously helped to pass into law about two years ago.

Strange as it might sound to the ordinary Kenyan, the Republican candidates are opposing this legislation — the closest their country has ever come to universal health coverage — mainly because, in their bigoted and narrow partisan view, it doesn’t leave sufficient choice for ordinary citizens. Blind political opposition can apparently spawn very strange policy positions!

In a landmark policy shift implemented at the beginning of this year, the National Hospital Insurance Fund (NHIF), our national health insurer, launched the Civil Servants Insurance Scheme under which all civil servants and their dependents will have access to enhanced in-patient and, for the first time, out-patient medical services as well.

The basic rationale for the scheme was two-pronged. The first theoretical pillar upon which this scheme was built was the belief, shared by both the NHIF and the Ministry of Medical Services, that every Kenyan deserves affordable medical care whenever he or she requires it

The second, probably less altruistic but no less important, was the conviction that the country cannot achieve its Millennium Development Goals or its Vision 2030 goalposts if the majority of its citizens do not have access to both affordable and decent healthcare.

These days, one of the most rational and enlightened measures of any country’s level of development is how that country treats its sick, especially those with rare medical conditions, those in emergency situations or those who cannot immediately afford to pay for all the medical care they need.

Over 600 hospitals

It is no longer sufficient to measure a country’s development or progress merely by the length of new tarmac roads built or the number of public universities chartered.

According to Richard Kerich, the CEO of NHIF, the Fund currently covers and serves almost 10 million contributing members of whom about 600,000, or about 23 per cent, work in the informal sector.

It already has over 50 branches and satellite offices spread all over the country and served by over 1,600 employees, with most of its basic services already being offered on-line. By last month, over 600 hospitals were accredited to the Fund.

Given its geographical spread across the country, the number of contributors and hospitals it currently serves and its other existing service networks, it is singularly difficult to see how this country can effectively and efficiently more quickly towards the provision of universal, decent and affordable healthcare without engaging the NHIF in one capacity or another.

To move ahead in such direction without engaging the NHIF would be akin to this country embarking a major medical research initiative while completely ignoring the existence or incipient capabilities of Kenya Medical Research Institute.

But in order to make the NHIF a more effective player in the achievement of our Millennium Development Goals or Vision 2030, we need not only to increase its professional and financial capacity but also to support it both professionally and politically as, apparently, the Minister for Medical Services Prof Peter Anyang Nyong’o, is already doing in large doses.

We need to understand both the Fund’s current and potential capabilities within our national development matrix.

And so one can understand our surprise and dismay when, last week, we saw a report in the local media to the effect that a number of top trade union leaders in this country were totally opposed to the new NHIF plans to raise the monthly contributions made to the Fund by the unionisable employees it has registered.

Even though the relevant and competent Kenyan courts have already given the Fund the green light to proceed, some senior trade union leaders have vowed to effectively negate the court rulings and the new deductions until they have been "fully consulted".

Sharing burdens

Under the new NHIF guidelines, the more a worker earns each month, the more, in absolute terms, he or she will be required to contribute to the national health insurer.

For example, those earning below Sh6,000 will be deducted only Sh150 while those earning over Sh100,000 will be required to contribute Sh2,000. One would have thought that these figures fit squarely into the principle of sharing national burdens in proportion to one’s ability. Just what more could their be to consult about here? Future union votes, perhaps?

The writer is a lecturer and consultant in Nairobi.

dominicodipo@yahoo.co.uk