Rutocare: Hard questions linger on new health plan

President William Ruto during the signing of Universal Health Care Bills, State House, Nairobi. [PCS] Veteran community health promoter Lilian Anyango, hummed a gospel song as she trudged a path in the rugged but picturesque Nyakach hills, Kisumu County. With a bulging red health kit bag slung on her shoulder, Lilian rounded an imposing hill and entered the home of her second client of the day- a middle-aged mother of four who is expecting her fifth baby. "May I take your temperature reading please," she told the mother as she pulled out a tiny thermometer from her bag nicknamed a mobile hospital. She inserts the thermometer in the client's left armpit. She withdraws the gadget, raises it against the light and declares: "Your temperature is good but remember your clinic visit is due in a week. I will call to remind you." Lilian is among the 100,000 community health promoters entrusted with making the new Universal Health Care programme a reality. She is not new to the game and is enthusiastic about her expanded role in the ambitious Ruto Care's Afya Yetu, Jukumu Letu programme. Unlike her colleagues in other counties who are embarking on the job for the first time, Lilian has been in it since 2018 when Kisumu was declared one of the four counties to pilot the Universal Health Care project. Others were Isiolo, Nyeri and Machakos. "They call me 'daktari' (doctor). In Kisumu, we have been doing this job since 2018. We are fully equipped and we are digital. We have smart phones in which we feed all the health details of the client, Lilian says with enthusiasm. She adds: "We no longer use the big exercise books. The information we get from the clients deep in the village is key because it helps the county government to plan on health delivery targets," Lilian spoke on Wednesday, a day before President William Ruto signed into law four health bills meant to revolutionise Universal Health Coverage in Kenya. The new health laws, touted as the solution to the Universal Health Care challenges in Kenya, has become the talk of the country. It has been widely covered in the local and international media. The Rutocare has left the country excited and anxious in equal measure. It was the main theme of Friday's Mashujaa Day celebrations held across all the 47 counties, with a climax at the Kericho Green Stadium -now renamed Kiprugut Chumo, where President Ruto gave details of how the new health laws will be implemented and how they will help Kenyans. But as the curtails fell on Mashujaa celebrations, where more than 100,000 community health promoters took oath of service, sang and cheered the President for the break of a new dawn, the hard part is now set to begin. A number of these health promoters who spoke to The Sunday Standard on condition of anonymity because they are not authorised to speak to the media, said they were excited but still lacked detailed information about their new assignments. "I know our patients out there will be asking us many questions about this new health care programme but we may not have answers," says a health promoter in Gem, Siaya County. Hard questions remain unanswered. Many Kenyans, it appears, have not fully understood how the new laws will affect their health insurance and pockets. The salaried population are sitting on the edge, calculating how the 2.75 per cent deductions to fund the programme will affect their already strained pockets. On the other hand, the jobless, low wage earners and vulnerable members of society are waiting for a health insurance windfall with bated breath. To them Rutocare will be an important turning point in addressing their health woes. How long, for example, will it take the national and county governments to demystify the new laws and actualise them? When will the taxpayer start benefiting from the re-energised Universal Health care? To many Kenyans, Rutocare still appears too complex to understand. The financial implications remain hazy. "The new UHC model was launched with fanfare, but how many Kenyans know how it will operate?" asks Rawlings Obwoga, a former consultant with the World Bank. He Adds: "The biggest assignment will be on public participation. The people must be educated on how the system works and how they can benefit without much trouble. It must be pointed out that it took many Kenyans, especially those in the villages a long time to understand a simple medical cover like NHIF." While launching Ruto Care at State House on Thursday after signing the four bills into law, President Ruto said: "Our national healthcare journey has been long and at times painful." He added: "Indeed, most Kenyans have always insisted that healthcare is the public service they want the most; it is the priority. Today, we have made a significant step towards making healthcare universal for all Kenyans." The bills passed into law are-the Primary Health Care Bill, 2023; the Digital Health Bill, 2023; the Facility Improvement Financing Bill, 2023; and the new Social Health Insurance Bill, 2023. The Head of State said the Kenya Kwanza manifesto committed to achieving UHC through a fully financed primary healthcare mechanism, comprising preventive, promotive, curative, palliative, and rehabilitative services. He said his government will ring-fence healthcare funds, through the facility improvement legislation at the national and county government levels under the Facility Improvement Financing Act, 2023 where every institution will keep part of the cash they collect from their operations. The new Social Health Insurance Act, Ruto said will now address financial barriers to healthcare and the existing challenges faced by NHIF by establishing a new agency, the Social Health Authority. The new Social Health Insurance law has now repealed the current National Health Insurance Fund and established three new funds including, the Primary Healthcare Fund, Social Health Insurance Fund, Emergency, Chronic and Critical Illness Fund. These funds will ensure publicly funded primary healthcare, emergency care and universal health insurance while promoting equitable access to quality health services. The new scheme requires salaried workers to contribute 2.75 per cent of their salaries to cushion the poor. This adds to the new taxes -including the recent 1.5 per cent housing levy which caused an uproar. Questions also abound on how the President will protect the UHC's huge budget from corrupt officials and how prudent it will be to use, to avoid financial pitfalls, that have bedeviled the first attempts to roll out the UHC, even in pilot counties. He promised tough punitive measures against corrupt officers who will dip their fingers into the UHC kitty. In the past, social welfare funds have been embezzled with impunity. Kenyans have been contributing between Sh150 to Sh 1,700 to the NHIF every month for the public health insurance. President Ruto has faulted this payment arrangement, saying it was unfair to the common person. "We have had a situation where the poor man is paying more money to sustain the person with high salaries. This is not good," said the President. In the new arrangement, the highly paid workers will be contributing a higher percentage of their pay. But will Rutocare succeed where earlier attempts to provide affordable healthcare for citizens have been elusive? Former presidents Mwai Kibaki and Uhuru Kenyatta made bold attempts to implement affordable healthcare but failed, with the most recent attempt being three years ago where the government piloted UHC in Kisumu, Nyeri, and Isiolo and Machakos counties. The pilot came with challenges, making the counties fall short in achieving their goals. Kisumu Governor, Prof Peter Anyang' Nyong'o who has been piloting the UHC in his County since 2018, is optimistic the scheme will succeed. "I support the President for re-engineering the Health reforms especially on the NHIF. As former Minister for Medical Services, I championed the Universal Health and transformation of the NHIF to a social health insurance. I recommended radical changes but I met stiff opposition from some quarters, especially the Federation of Kenya Employers," says Prof Nyong'o who is also a former Chairman of the Health Committee at the Council of Governors. He adds: "I thank President Ruto for biting the bullet for revolutionise the country's health system."

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