Invest in system-wide changes for Universal Health Coverage

Over the next few years, the National Hospital Insurance Fund (NHIF) will grow into a behemoth with a huge reserve of financial resources. If all goes according to plan, more contributors will be roped in, and contributions will be markedly enhanced as employers and other players begin to pay into the fund. One expects that the services covered by the fund will also expand and the limits of reimbursements will rise. This is the government’s way of guaranteeing universal health coverage, and every government statement on this matter does not fail to mention NHIF.

It is this realisation that may have informed recent government moves to propose changes to the NHIF board structure giving the Cabinet Secretary complete control, including the authority to give directives on fund usage. The proposals eliminate stakeholder oversight and make NHIF a more direct extension of a Ministry of Health better known for being a conduit for corrupt government officials and their cronies to enrich themselves. Any objective observer would conclude that these changes are very ominous given this background.

MISCHIEF AFOOT

Another curious proposal is for the fund to begin investing ‘excess’ funds in equities, fixed deposit accounts and even in property. It would appear that the intention is to replicate what is happening at the National Social Security Fund (NSSF). Unfortunately, there are numerous differences between the two institutions. The NSSF collects contributions from workers with the intention of investing them and growing the fund in order to guarantee a good retirement package for them. NHIF on the other hand collects money from all and sundry in order to guarantee payment for certain medical needs during the period one remains covered.

Money collected by NHIF is not meant to be given back to the contributor at any point in time, unlike what happens at NSSF. We therefore contribute to NHIF knowing fully well that our money will be pooled with that of other contributors in order to cover the medical costs of any contributor that may fall ill during that period. The more money NHIF collects, the more generous one expects the cover package to be. Claiming to have excess funds and trading with contributors’ funds while there is still a huge unmet need for coverage is disingenuous to say the least, and leads one to the inescapable conclusion that there is mischief afoot.

INTENTION TO LOOT

The problem in this country is that we often correctly diagnose problems but then go ahead and prescribe treatments that are at best inappropriate and at worst even detrimental in the final analysis. It also turns out that when public officials are bent on stealing from the national coffers, they often propose complicated schemes and grandiose projects that enable them to loot without consequences. Whoever came up with these proposals to amend the NHIF Act was shamelessly telegraphing to us their intention to loot, and should the amendments be passed by parliament nobody should be surprised when evidence of looting comes to light in the near future.

While the government’s commitment to improving the health of our people must be supported and encouraged, it bears repeating that more needs to be done beyond having NHIF coverage for the majority of Kenyans. A good starting point is to emulate what the Makueni County government is doing. The system in the county has been organised to ensure that not only do curative services improve, but also that primary health care, encompassing health promotion and prevention of diseases is addressed.

ACCOUNTABLE MECHANISMS

For the best sustainable outcomes, we must invest in training, in recruitment and smart deployment of the health workforce, in research, and in establishing accountable mechanisms that also address the social determinants of health. Funds meant for health services must therefore be carefully spent on all these in addition to curative services, and any suggestion of there being ‘excess’ funds while these areas remain inadequately funded is ludicrous.

Finally, we must constantly remind ourselves that universal heath coverage is not synonymous with insurance cover for specific diseases. Ensuring that people live in healthy environments, and preventing ill health using localised interventions must be key components of any health campaign.

Lukoye Atwoli is Associate Professor of Psychiatry and Dean Moi University School of Medicine; [email protected]