Governors clash with ministry over health laws

Tharaka Nithi Governor Muthomi Njuki. [Phares Mutembei, Standard]

Governors have faulted the Ministry of Health for failing to engage them in the ongoing formulation of health laws.

The Council of Governors (CoG), through health chairperson Muthomi Njuki, said county governments were sidelined in the initial process of formulating laws and regulations.

Njuki warned that this may affect the implementation of the laws, as health is a devolved function.

“I will not belabour the fact that health is primarily a devolved function and therefore in legislating we must draft laws that are county responsive,” he said during validation of the Social Health Insurance Regulations, 2024, on Monday.

The laws formulated include Primary Health Care Act, 2023, Digital Health Act, 2023, Facility Improvement Financing Act, 2023 and Social Health Insurance Act, 2023.

The Acts were assented to by President William Ruto on October 19, 2023, and would be aggregated under the Social Health Insurance Act (SHIA), 2023.

To implement the Act, the Ministry of Health established regulations to oversee their actualisation.

President William Ruto assented to four health Bills on October 19, 2023.

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“I was emphatic that there were provisions of the Social Health Insurance Act, 2023 that the County Governments were not comfortable with,” said Njuki.

The governor handed over the CoG memorandum to Health Cabinet Secretary Susan Nakhumicha during the validation of SHI Regulations, 2024.

In the memorandum, governors want all pending bills owed to county governments under the National Health Insurance Fund (NHIF) settled in the transition to the Social Health Insurance Fund (SHIF).

The county bosses want efficiency in the flow of funds from the Primary Healthcare Fund, the Social Health Insurance Fund and the Emergency Chronic and Critical Illness Fund to healthcare providers including county governments.

Under the Digital Health Act, they emphasised the need to ensure the readiness of all administrative, technical and digital systems to ensure implementation of the Act in July.

Further, governors have called for consideration of indigents without national identity cards, considering registration under the Act requires a national ID.

Despite the regulations having been validated, the leaders want elaborate awareness campaigns of the new health scheme.

“There is also a need for sensitisation and awareness creation for all persons on the requirements for registration, implementation and benefits under the Act,” reads a section of the memorandum.

“There is a need for further legislative scrubbing to ensure there are no inconsistencies and that they are aligned to the devolved systems of government, good governance and the reality on the ground,” said CoG in the memorandum.

Nakhumicha acknowledged the concerns and promised to address them for the smooth implementation of the health agenda.

“I have heard what you have said, governor. I think we were running very fast, and my team was working with a target of March 1, but having listened to Governor Muthomi, I think there is one slight step that we need to consider so that we have everyone on board,” the CS said.

“Just to confirm to you governor, we are here to work together. There is no patient for county government and patient for national government,” she added.

The CS assure that the Ministry of Health will work together with county governments to ensure the provision of quality healthcare to Kenyans.

“...so whatever it will take for the national government to work with county governments, that we shall do,” she said.

Nakhumicha reiterated that the Ministry of Health is committed to ensuring a seamless transition from NHIF to SHA.

“We are working very hard to ensure Kenyans do not notice (changes) even at the point of shaking hands, and I have feedback that SHA and NHIF board have been working together very closely,” said the CS.

Njuki raised concern over the manner in which the laws are being rushed. “The transition from NHIF to SHI must not be rushed when the Act provides adequate timeliness for a seamless process,” he said.

“Let’s handle the transition carefully to minimise service disruption to our people,” he added.

The governor noted that the transition committee tasked to oversee the repeal of NHIF to SHA does not have a representative from CoG.

The transition committee is chaired by Jason Kap-Kirwok.

Members of the committee include Dr Daniel Mwai (presidential health advisor and health economist), Dr Kipruto Chermusoi Chesang, Dr Jacinta Wasike, Gladys Wambui Mburu, Stephen Kaboro Mbugua and Dr Elizabeth Wangia.

Other members are Christopher Leparan Tialal, Dr Jacob Otachi Orina and Dr Stanley Bii.

The committee is mandated to develop a legal and institutional framework for the coordinated transition to SHA.

Further, the Health CoG chairperson said the enforcement aspects for the informal sector, required to contribute to the scheme annually might not be attained, and would take the country back to struggles that were faced with NHIF.

He called for further harmonisation of the laws to remove inconsistencies and ensure regulations are aligned to the devolved systems of government, good governance and the reality on the ground.

Njuki said to effectively operationalise the Social Health Insurance Act, co-operation is key.

“On this note, let me urge the Ministry of Health to always ensure consultations and concurrence of the Council of Governors and county governments as we move forward with the Social Health Insurance mechanisms,” said Njuki.