CS Nakhumicha explains why high earners should pay more for Social Health

Health CS Susan Nakhumicha during a meeting with the Joint Committee of the National Assembly and the Senate Health Committee scrutinizing the new SHIF health scheme at the Argyle Hotel in Machakos on February 27, 2024. [Boniface Okendo, Standard]

Health Cabinet Secretary Susan Nakhumicha has explained why maximum pay was not considered in the newly enacted health laws.

She said such would not help raise enough resources to provide quality services to all Kenyans.

Nakhumicha said the capping will enable the Ministry of Health raise enough resources to provide care for primary health care, critical and emergency services.

"None of those involved in public participation has given a contribution on capping. If we cap, we will compromise the yield, and we will go back to the issues we are facing," Nakhumucha told the committee.

She was speaking Tuesday when appearing before the Senate and National Assembly Health committees.

According to the Social Health Insurance Regulations 2024, capping has only been placed on minimal pay.

Each Kenyan shall however pay 2.75 per cent to the Social Health Authority (SHA), which will repeal the National Health Insurance Fund (NHIF).

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The CS explained to the Uasin Gishu senator Jackson Mandago chaired committee that all Kenyans shall access packages equally, regardless of their contribution amount

"There are no exclusions, including congenital diseases, we have not excluded anyone in the new health scheme," the CS said

She added, "With the benefit package, we must then think of how to raise resources to benefit from the package to benefit 50 million Kenyans."

There has been uproar from salaried Kenyans saying the deduction is too high.

In the scheme, MPs will pay approximately Sh27,000 to the scheme.

"One per cent increase is not too much to ask for. You being MPs, you give more," said Nakhumicha.

Nakhunicha was hard pressed by Nyamira Senator Okong'o Omogeni, seeking answers as to why there is no capping on the highest contribution, as the initial capping had been placed at Sh5,000.

The senator also demanded to know how the ministry arrived at the 2.75 per cent deduction cap to the new scheme.

On non-salaried people, he sought to know the means testing that shall be used to determine how and the amount to be paid to the scheme.

"...are you telling us between now and June, you'll have visited all homesteads, accessed their homes and given feedback on what they should pay, I need to understand how you will visit homes and determine the income of all households," said Omogeni.

Acting NHIF CEO Elijah Wachira said capping was among issues raised during public participation.

"The 2.75 percent was also perceived high, especially for high-income earners," Wachira said.

The means testing was also an issue of concern where with participants poking hopes about the effectiveness, fairness, and frequency of assessments in informal sectors and polygamous families.

Advertisements for public participation were done in December 2023 and February 2024, where different stakeholders were engaged at different periods.

Mass public participation took place on February 12, to February 21, 2024.

Wachira told the committee that key issues raised on primary Healthcare Fund was accessibility, out-of-pocket expenses, and benefits portability.

On accessibility, the issues raised were access to services during operational hours and for those living near high-level facilities lacking nearby lower-level facilities.

On out-of-pocket, the issue was costs as a result to drug shortages, in most hospitals.

After completion of public participation, SHA recommended massive civic education campaign on the regulations, increased funding and resources to improve infrastructure, staffing and service delivery.

The Acting Corporation Secretary SHA Terry Rotich emphasised service delivery at the Primary Health care fund is a fully publicly financed fund providing services at Level 2 and 3 or a level 4 primary.

To access this service, everyone must register with SHA, and the initial registration, every person is required to apply to SHA, by June 30, 2024.

Payment of contribution and access of services to commence of July 1, 2024.

On 2.75 per cent capping, economist at the Ministry of Health Stephen Kaboro told the committees that the decision was done to meet a comprehensive benefit package for all Kenyans.

"Those who earn more, should pay more, and this is what we have been running away from NHIF.

The capping was also determined on collection, if low, it could affect the benefit package we have," said Kaboro.

Seme MP James Nyikali demanded answers on how the health scheme will handle salaried employees who also earn handsomely from businesses.

PS Public Health Mary Muthoni said that the views of legislators were crucial.

"Capping is an issue that is still ongoing, and we would need your views as parliamentarians. We went to the ground and some people are for, while others are against. What are your views by MPs on this?" said Muthoni.

Wachira said that the views of MPs and Senators shall be incorporated. "Every input shall be interrogated technically and incorporated," said Wachira.

Nakhumicha reassured the committee that the Ministry of Health to actualise the health agenda.

"We have been working, even before bills, we were working towards attaining UHC, the ministry had policies towards attaining UHC, we have prolonged to achieve the areas, apart from robust laws that need scrutiny, for refining," said Nakhumicha.

She added: "adding that she is confident that registration to the new scheme will officially commence on the first week of March, ahead of contribution in July.