Government needs Sh86bn for HIV patients' free insurance

Kenya requires nearly Sh86.3 billion by January if it is to include HIV treatment in the national health insurance package, the Nation can exclusively reveal.

Antiretroviral drugs (ARVs) are provided by the government for free in public health facilities, or at a cost in private ones.

The National Hospital Insurance Fund’s (NHIF) comprehensive HIV package will cover in-patient, out-patient, HIV testing and counselling, antiretroviral therapy (ART) and pre-exposure and post-exposure prophylaxis (drugs given before or after exposure to the virus to prevent HIV infection in people who do not have the virus).

It will also give coverage for tuberculosis prevention and care, non-communicable diseases and maternal healthcare in NHIF-accredited health facilities.

DEPRESSION

This translates to an annual cost of Sh42,000 per person, show preliminary findings of the Actuarial Evaluation to Assessing Costs and Feasibility of Integrating HIV Treatment Packages into NHIF to Cover People Living with HIV in Kenya report seen by the Nation.

However, family planning and nutrition, which are part of the Kenya ART guidelines, will be excluded from the new cover.

READ: HIV patients gain 10 years: study says

Vaccine and immunisation for Hepatitis B and C and treatment for depression and alcoholism, also in the guidelines, are yet to be included.

In April last year, the National Aids Control Council (NACC) executive director, Dr Nduku Kilonzo, praised the cover as a sustainable method to provide treatment as opposed to donor funding.

PRIVATE SECTOR

Donors have traditionally supported Kenya’s healthcare, providing Sh7 in every Sh10 set aside to address HIV — which nearly Sh1.64 million Kenyans have — and the figure could shoot to Sh6.9 million by 2060.

The gap is filled by the government, private sector, households and non-governmental organisations.

But the donor stream is unpredictable and fragmented and often fails to arrive when it would do the most good, says communication to the Cabinet from the NACC, which warned that HIV is becoming less of a medical calamity and more of a fiscal liability.

This is because once infected with the virus, a patient requires lifetime treatment with anyone who tests positive for HIV put on treatment immediately.

GLOBAL PURSE

As a result, the Cabinet, particularly the National Treasury and Health ministries, are called upon to shift from reliance on the global purse to local domestic financing so as to enhance “the dignity and health sovereignty of Kenyan people”.

In the last Cabinet meeting of President Mwai Kibaki’s administration, the idea of a long-term sustainable financing mechanism for HIV and non-communicable diseases was mooted.

READ: Health insurance: Why you should get an NHIF cover

That was aimed at cushioning the country from reduced development partners’ financial support as well as have resource outflows into the NHIF scheme for risk equalisation of HIV treatment.

The preliminary report shows that it would cost about Sh19.6 billion this year should the government opt to provide either in-patient or out-patient services only.

If only ARVs are offered, however, it would cost Sh47.1 billion.

COMPETING FUNDING

Coincidentally, about Sh600 million is allocated in the recurrent HIV budget and Sh75 million in development estimates in the 2017/2018 financial year — barely five per cent of the Sh87 billion needed for HIV treatment.

Of late, however, donor funding has been reducing due to competing funding for other diseases such as non-communicable diseases.

The rebasing of the Kenyan economy to a lower middle income country status in 2015 means Kenya may not procure ARVs and related commodities using pre-negotiated prices meant for poor countries from 2018/2019; this will take effect in 2020.

Further, the Trade Related and Intellectual Property Rights Agreements (Trips) dictates that, having so graduated, Kenya is expected to procure its ARVs and related commodities at market prices.

STATE HEALTH FUND

These are some of the issues that NHIF chief executive Geoffrey Mwangi spoke about on Tuesday at the Maisha Aids Conference, which ends on Wednesday in Nairobi, on the cost and financing opportunities of integrating HIV treatment into the State health fund.

The actuarial analysis proposes three broad HIV financing options: Fully funded — where the NACC pays the insurance premium for HIV-positive Kenyans; direct payment by HIV patients; and lastly, a hybrid method, partially funded by a third party.

Afya House this month submitted a request for a Sh36 billion grant from the Global Fund to cover HIV, malaria and TB.

The fund, which was set up in 2002, has disbursed nearly $888 (Sh89 billion) to Kenya and finances projects at the Kenya Red Cross Society, Kenya Aids NGOs Consortium and Amref Health Africa, among others.