Universal Health Care: The haves will have to pay for the have-nots

National Hospital Insurance Fund card. [Elvis Ogina, Standard]

Implementation of the Universal Health Coverage (UHC), one of President Uhuru Kenyatta’s pet projects, will succeed largely through enforcement of mandatory contributions to the public health insurer.

The UHC Taskforce says the National Hospital Insurance Fund (NHIF), which is the best vehicle to implement the programme, might face financing headwinds due to poverty and budgetary constraints from the national government.

For starters, the government only spends less than seven per cent of the total budgetary allocation on health, which is way below the 15 per cent Kenya signed to during the Abuja Declaration in 2001.

Money allocated to healthcare is thus not enough for smooth implementation of the changes in the new NHIF Act Whose major financing agents under the pooled funds are the Ministry of Health, county departments of health and the NHIF.

“The government will have to tax people to generate revenue. If not, the government will pay for the service,” said UHC Taskforce chairperson, James Wambugu.

He also told the Standard that the taskforce came up with different models of guaranteeing success of UHC. NHIF emerged as the best body to run the health scheme in which the haves will pay for the have-nots. Kenyans, he said, will have no choice but to pay in the face of an increasing burden of communicable and non-communicable diseases.

“We identified poverty as a gap in implementation of UHC and the reason why we need those in a position to pay to remit the pay. If people find drugs and timely treatment in hospitals, they will pay for NHIF,” said Wambugu.

That way, he added, the government will meet a smaller percentage of paying for the vulnerable and poor, but UHC will also only offer basic and necessary services otherwise, patients who are choosy with questions whether hospital beds have side drawers “can get such in a private facility at their own extra cost”.  

NHIF CEO Peter Kamunyo, said many Kenyans will also benefit from uniformity of costs in all hospitals with contracts.

“NHIF will pay equal amount of money across all hospitals where Kenyans seek services, at a standard cost,” said Dr Kamunyo.

He added: “All hospitals will get money from NHIF and grow the projects in respective hospitals. We shall ensure there is supply of drugs and smooth service delivery.”  

With comprehensive health scheme, he added, every Kenyan will walk to any contracted hospital and receive all services, without paying- ‘Afya bila stress.’

But Prof XN Iraki of the University of Nairobi School of Business argued that the sustainability of UHC, being a cost sharing programme, will largely depend on timely remission of money and curbing bureaucracy at the central and county governments.