Another blow to Ruto’s health plan as Senate rejects new legislation

President William Ruto’s new healthcare plan has hit a snag after a Senate committee rejected two proposed supporting laws.

In a report to the Senate, the Delegated Legislative Committee chaired by Senator Tharaka-Nithi Mwenda Gataya Mo Fire has recommended the repeal of the General Health Insurance Ordinance, 2024 and the General Health Insurance Litigation Ordinance, 2024 due to lack of public participation.

These two pieces of legislation are crucial for the implementation of the Health Insurance Fund (SHIF).

The committee accuses Health Cabinet Secretary Susan Nakhumicha of failing to provide a satisfactory explanation of the formula used to calculate the 2.75% annual contribution to household income and the lack of data security.

The recommendations came just hours before Ms Nakhumicha announced an extension of SHIF implementation from July 1, 2024, until October.

However, registration is expected to begin on Monday.

But even as Ms Nakhumicha announced the extension, the Senate panel’s recommendation means the implementation of SHIF could be delayed even further.

“The Ministry of Health was given ample time and opportunity to present evidence of public participation, but this never happened,” the report reads.

Senator Vihiga Godfrey Osotsi has stated that the registration of Kenyans in SHIF before the implementation of the implementing regulations is contrary to the Constitution.

“The minister should not put the cart before the horse because the new program will be quickly rejected,” Osotsi said.

The launch of SHIF was originally scheduled for April, but was postponed to July 1 due to the adoption of the Social Health Insurance Act earlier this year.

The implementation of the law is entirely dependent on the adoption of both legal acts.

The Social Health Insurance Act and Regulations provide for new registration for Kenyans and residents of the country.

“In preparation for the implementation of social health insurance and its benefits, I am announcing that registration will begin on July 1, 2024,” said Ms. Nakhumicha.

She added that the exercise will be nationwide and will involve online self-registration or assisted registration by local health promoters, at National Health Insurance Fund (NHIF) offices and other points designated by the Social Health Insurance Board.

The government says the move to SHIF is a step “towards a more inclusive system that addresses basic healthcare needs and offers a wide range of medical services”.

He says the transition aims to provide holistic healthcare by expanding coverage and lowering costs.

Article 50 of the Social Health Insurance Act authorizes the CS, in agreement with the Board, to issue regulations improving the implementation of the law.

The Ministry prepared two legal acts, which were later published by Ms. Nakhumicha on March 8, 2024. They were then submitted to the Senate for consideration.

The draft rules were tabled on 20 March and referred to the Committee on Delegated Legislation for consideration before being transmitted to the House of Representatives.

The committee expected the CS to appear before it and show how the ministry had taken into account the views and concerns of the public and other stakeholders in rules and regulations.

In presenting the legislation to lawmakers, Ms Nakhumicha provided an impact assessment, an explanatory memorandum and a table detailing public participation.

In accordance with Section 16 of the Statutory Instruments Act, the committee invited Ms Nakhumicha and other players to discuss the regulations. The invited stakeholders include the Board of Governors, the Kenya Medical Practitioners and Dentist Union and the Kenya Medical Association. CS, however, did not turn up.

“It failed to provide evidence of adequate public participation following the preparation of regulations and rules that satisfactorily took into account the concerns of the public and interested parties concerned,” the committee said in a report due to be debated in the House.

“This was contrary to sections 10 and 118 of the constitution and section 5(a) of the Statutory Instruments Act.”

The Senate panel says in its report that Ms. Nakhumicha did not emphasize the financial impact of regulations and laws, even though they have a huge potential impact on society.

Social Health Insurance introduces a three-tier approach to financing health care – the Primary Health Care Fund, SHIF and the Emergency Assistance Fund and the Chronic and Critical Illness Fund.

In the justifications presented to the committee, the ministry was unable to justify the existence of three levels of benefits or a benefits package.

She also never provided any explanation for switching from one fund to another after exhausting benefits from one fund.

Regulation No. 21 of the Universal Health Insurance Act of 2024 provides for the methods of carrying out tests.

This method uses an instrument to determine whether a given person or household has the ability to pay social health insurance contributions.

The means survey tool was to be used to collect household data. Ms Nakhumicha developed the tool in collaboration with her colleague at Social Protection.

“The ministry was unable to explain the formula used to calculate the 2.75% annual contribution to household income or how the income measurement instrument can be challenged,” the report said.

The Commission is also concerned about the lack of clarity on the transition from NHIF.

The First Schedule of the Social Health Insurance Act provides for a smooth transition from the NHIF. The Committee is, however, concerned that NHIF cardholders will be rejected by hospitals.