Samwel Kumba
5 September 2008
Nairobi — Working Kenyans will soon have to pay medical bills for the unemployed, if a new plan to help the poor access health care is adopted by the Government.
And it means a massive increase in health contributions by people with jobs.
Currently workers pay a maximum of Sh320 a month while voluntary contributors give Sh160.
But details of the new scheme obtained by the Saturday Nation show contributions will be paid as a percentage of earnings -- between two and 2.75 per cent.
This means people earning Sh20,000 a month will pay Sh400 while those earning Sh100,000 will have to part with about Sh2,500 a month.
New scheme
Under the new scheme a sick person will need only Sh20 for treatment at a public hospital.
The money, currently paid in government clinics and hospitals as the "card fee", will grant automatic registration to the proposed new National Hospital Social Insurance Fund (NHSIF).
The new scheme is intended to cushion the health fund, a State corporation which is finding health costs too much to finance compared with members' contributions.
If approved, the scheme will roll out at a time when a majority of Kenyans, especially those living in the rural areas, are unable to access basic health services.
It will also go a long way towards boosting the Government's goal of health for all Kenyans by the year 2020.
Medical Services minister Anyang' Nyong'o confirmed that the new scheme's main goal was to make health care accessible to all Kenyans.
However, he said he could not discuss details before presenting the proposal to the Cabinet.
Prof Nyong'o said: "Our health system is a major contributor to the widening gap between the rich and the poor. This scheme will to a large extent address this anomaly."
The minister said extra resources will be required to extend free medical services to those who cannot afford it.
"Our concept will bridge the disparity that exists in health care access between the haves and the have nots. We cannot achieve Vision 2030 with the current vulnerability of the poor," he said.
This concept is, however, not new in the local health sector. Four years ago, attempts by the then Health minister Charity Ngilu to introduce a similar plan were thwarted when President Kibaki rejected it.
Prof Nyong'o, who was then minister for Planning and Economic Development, had played a key role in drafting of the Bill.
Then Finance minister David Mwiraria supported the President saying the Government could not afford to finance the scheme.
It also came under sharp criticism from the private sector as it compelled employers to remit money to the fund. The Kenya Medical Association also expressed reservations about its implementation.
The new scheme which is set to be tabled before the Cabinet any time now, is an amended version of the 2004 plan.
Whereas the previous proposal envisaged a new Bill for a compulsory and comprehensive social health insurance scheme which would have compelled employers to contribute to the scheme, the new one exempts employers.
Another change is that instead of workers contributing fixed amounts, the new contributions will be calculated as a percentage of each individual's earnings.
Contribute
"This means those with higher salaries will contribute more to the fund than those who earn less," Prof Nyong'o said. The scheme, however, proposes a limit up to which those with higher salary scales can pay.
By exempting employers from making payments, Prof Nyong'o said it will mean they will continue with existing medical schemes for their staff.
This means some workers will contribute to the fund but they will not be able to take advantage of its benefits, except as in-patients.
The scheme projects that 65 per cent of Kenyans will be able to access health care seven years from now. The demand for the rest will be catered for in the subsequent five years.
Though formed in 1966 through an Act of Parliament, NHIF's current operations are based on amendments made in 1998.
The fund's chief executive, Mr Richard Kerich, said current contributions were below meaningful health financing.
"Times have changed and a large group of contributors are earning above Sh15,000. Health care has skyrocketed and revising the Act is the only way to go."
Increasing the contributors' base to include more retirees and the unemployed was the fund's growth area.
"We are keen on preventive measures as an overall need for Kenyans as opposed to the current system that is curative," said Mr Kerich.
Once rolled out, the plan will see the sick given NHIF numbers when they first seek medical attention at dispensaries and other public hospitals.
The fund will then give such people regular review dates, especially for preventive health care. Contributions to the fund are statutory and all employed people are legally bound to remit the money.
Saying the previous proposal faced resistance from the private sector, Prof Nyong'o said partnerships with employers and workers' unions would be sought before implementation.
"It is because of the experience we went through while pursuing legislation to accommodate the earlier proposals that we have changed tack. We want to overcome the problems we faced then," said the minister.
Implementing the new scheme will be an uphill task as Kenyans are already grappling with new costs of electricity and consumer goods across the board.
The minister can, therefore, expect resistance from workers, who will not take lightly any move that cuts their already stretched salaries.
A cross-section of workers' unions yesterday sent strong signals that they would oppose the scheme.
The Union of Kenya Civil Servants warned the Government against any un-negotiated deductions from its members.
Secretary general Tom Odege said that although the union supported the scheme, the minister should have involved all stakeholders especially on the financial implications on targeted contributors.
He said: "A salary is an employee's right. The Government cannot go on budgeting on somebody's salary without formal consultations."
Mr Odege criticised the health plan as "full of assumptions" and warned that civil servants would not accept any new levies.
Taxed twice
The Kenya Union of Domestic, Hotels, Education Institutions and Allied Workers (Kudheiha) secretary general Albert Njeru said open forums were vital to make workers feel part of the scheme.
"We agree it is good. But the workers will not agree to have their money taxed twice for the same services," Mr Njeru said.
He added: "We shall not accept a deal that is made in the boardroom. We must be aware of the contents so that we tell the minister to go on or leave it. As of now, he is working alone."
The umbrella workers union (Cotu) rejected the proposal on the basis that members had not been involved.
Secretary general Francis Atwoli said the scheme has been prepared haphazardly.
"It is difficult to tax workers any more. They already give the taxman money for things like health. The Government cannot have this proposal without telling workers how they will benefit directly."
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