David Okwembah
28 December 2004
Nairobi — Cover for HIV/Aids patients has been worked into the new Sh40 billion state health fund.
But the amount of financial help has not been fixed and will be worked out only once the scheme has started.
In addition to the minimum benefits that everyone will receive, members of the National Social Health Insurance Fund will also be covered for tuberculosis, malaria, reproductive health, expanded primary immunisation, food safety and control of communicable diseases.
Patients who consult traditional healers will also be covered under the new scheme proposed in a final draft, the Standard Benefit Package, crafted by the Ministry of Health and the Fund.
The scheme puts benefits in five levels that run from the lowest - private clinics run by doctors, nurses, clinical officers and the traditional healers - to the highest level made up of specialised in-patient and out-patient care.
The minimum benefit package, which all members receive as out-patients and in-patients, includes:
- Medical consultation with a doctor, clinical officer or nurse including home visits where necessary;
- Specialist care in hospitals and clinics for out-patient and in-patient care;
- Drugs and essential medical supplies;
- Hospitalisation where necessary;
- Dental care;
- Medical rehabilitation including necessary appliances;
- Referral including specialised treatment overseas where necessary; and
- Any other benefits approved by the National Social Health Insurance Council.
The package is awaiting President Kibaki's signature to pass into law the National Social Health Insurance Fund Bill. It was passed during an acrimonious session in Parliament before MPs adjourned.
During the debate, Health minister Charity Ngilu unsuccessfully tried to move an amendment to make the health scheme optional.
But backbenchers both on the Government side and for the Opposition ganged up to throw out the amendment, and thereby making the scheme compulsory.
There has been speculation that this might encourage the President to decline to sign the Bill and instead return it to the House with his own suggestions for further debate.
The Standard Benefit Package proposes the exact value of the benefits be fixed when the scheme is in place.
This puzzled health experts who pointed out that even in its current state, the NHIF clearly states how much rebate each in-patient receives at hospitals.
The highest rebates of Sh2,000 a day are for the private wing of Kenyatta National Hospital. Patients at the more expensive Nairobi hospitals - Nairobi, Mater and the Aga Khan - receive Sh1,400 a day.
Provincial hospitals and the general ward at Kenyatta National Hospital offer Sh1,000 a day for in-patient care.
The NSHIF package was developed by a 15-man committee chaired by the director of medical services, Dr James Nyikal.
All government, private and mission hospitals will be classified in six grades according to the services they offer.
"Since all Kenyans will be enrolled in the scheme, it is likely that members with high incomes may require services that are more expensive than those covered by the basic benefits package," the document states.
The wealthier members can supplement their basic package by either private insurance or direct extra payment, the document adds.Costing services was hindered by lack of data. "It was therefore not possible to get the actual cost of the package," the document states.
Other proposals include improving public hospitals and clincis, improving supplies and health personnel management, and decentralising government health care and establishing a national standard for treatment.
The ministry of Health and NHIF note that the benefit package is a complex document, tedious to develop and prone to frequent changes caused by developments in medicines and care.
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