Include cancer management in the new health insurance fund

NHIF building, Nairobi. [File, Standard]

The government seeks to make radical changes in various sectors with the aim of improving the lives of both private and public workers, especially on health. Article 34 (1, 2) of the Employment Act provides that the employer should ensure sufficient medical care of employees.

This is what birthed the idea of a comprehensive medical cover for teachers and other civil servants, which was, and continues to be a welcome and timely move. Before, teachers had been exposed to embarrassing situations every time they fell sick.

So much so that the coming of AON-MINET in July 2015 was a reprieve to many who were in dire need of medical attention. The scheme came along with some products that cushioned teachers' health needs, including their wellness. The intention was to address direct aspects of illness that drained teachers' resources.

We have heard testimonies and even seen what the cover has been able to do for some of our colleagues who had chronic, but very resource-draining cases. We witnessed our colleagues being flown out of the country for specialised care under the MINET medical insurance arrangements. That would not have been possible if the insurance cover was not there for us.

The President, however, plans to make it mandatory for every household to contribute 2.75 per cent of its income to fund a new Social Healthcare Fund that will see the government take a colossal amount of money to the health care basket. The Social Health Insurance Bill, 2023 will also make it mandatory for all Kenyans to become members of the new Social Insurance Scheme, which will replace the current National Health Insurance Fund.

To fund the grand health scheme, the government plans to increase deductions from the current range of between Sh150 and Sh1,700 to a flat rate calculated at 2.75 per cent of gross monthly earnings.

Under the proposed new outfit, State-backed Social Health Insurance Bill 2023, Universal health coverage (UHC) will be re-modelled on three separate funds; one for preventive and primary health care, another for primary referrals and a third covering treatment of chronic diseases. This is part of the plan by the president to deliver the UHC promise. The Bill provides for the reorganisation of service delivery at the primary health care levels, including dispensaries and health centres.

But to actualise the dream, the government will line up regulations that will make membership in the new health care compulsory in a bid to rope in the 80 per cent of Kenyans in the informal sector to contribute to the scheme. Those without proof of up-to-date contributions will be denied State services under the regulations that will bring social health care membership to the same league as Kenya Revenue Authority personal identification numbers.

The three separate funds; one for preventive and primary health care, another for primary referrals and a third covering treatment of chronic diseases, as a remodelled approach could be our focal point given the current circumstances.

Management and treatment of cancer have become expensive to teachers, other public servants and the general public. With the existing medical insurance arrangements for teachers; the cover gets depleted mid-way, leading teachers to mobilise more resources through well-wishers, fundraisers and the selling of personal property in order to have the ailments taken care of.

Cancer management has been categorised by the insurer for both outpatient and inpatient packages. The highest a teacher can get for outpatient in job grade C4 is Sh150,000 whereas the inpatient package is allocated Sh1,000,000. The benefits (paid net of NHIF rebates) under this cover include bed entitlement, doctor's fees (physician, surgeon and anesthetist fee). ICU/HDU/Critical care and theatre charges, medicines, dressings and internal surgical appliance. Cancer treatment and related procedures and tests.

Outpatient benefit includes the treatment that does not require admission or day care surgery in a hospital. The outpatient cover caters for all routine outpatient services which include routine outpatient consultations, prescribed diagnostic laboratory and radiology services (X- ray, ultra-sound and MRI and CT scans).

This then brings us to the question of whether the Teachers Service Commission has plans higher amount for management of cancer and whether or not this arrangement can be accommodated in the new outfit. We say this because in a period of one year, the Kenya National Union of Teachers has lost four of its national leaders to cancer and has been left with huge bills to pay.

Many of our members silently suffer in their villages with cancer with their little pay and no one to listen to their problems. Prominent Kenyans, endowed with resources, have too succumbed to the menace even after trying with all their might. Cancer needs keen attention.

When Kenyans asked government to declare cancer a national disaster, what did it mean? Does it have anything to do with the manner and way in which it is handled, including providing sufficient infrastructure for managing the disease? If yes, then the proposed changes in the Social Health Insurance Fund should populate ideas on cancer management for teachers and public servants in Kenya.