MoH takes heat from senators over new SHIF rollout

The Ministry of Health was on Wednesday put to task to explain its preparedness to implement the Social Health Insurance Fund with only 10 days left before its official launch.

The Senate Delegated Legislation Committee said it was very clear that the country was not ready to implement the new scheme that is supposed to replace NHIF starting July 1, 2024, with a lot supposed to be done to ensure its success.

Makueni Senator Daniel Maanzo asked Health Principal Secretary Harry Kimtai who appeared before the Committee in Parliament to demonstrate the country was ready to embrace the new scheme amid claims many Kenyans are not registered.

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“There are very many Kenyans who were not registered for the National Health Insurance Fund which is the precursor of the Social Health Insurance Fund which is supposed to commence on July 1, we have less than 10 days to go and we are very certain that the country is not ready for this scheme,” said Maanzo.

His Machakos counterpart Kavindu Muthama said that the necessary tariffs needed to be gazetted early enough and that the ministry needs to prove that it carried out public participation to avoid legal hurdles that might come into the way for the new scheme.

But Kimtai told the committee that the Social Health Insurance Regulations 2024 will provide for the implementation of the Primary Healthcare Fund, the Social Health Insurance Fund and the Emergency, Chronic and Critical Illness Fund.

The PS said the Social Health Insurance (Tribunal Procedure) Rules,2024 will operationalise the Dispute Resolution Tribunal established under section 44(1) of the act.

He said the purpose of the statutory instruments is to give effect to the provisions of the Social Health Insurance Act, No.16 of 2023 with parliament having enacted the act on October 19, 2023.

The act came into force on November 22, 2023, through a gazette notice issued by the Health Cabinet Secretary.

“The Act on its own, however, is not sufficient since it does not provide the modalities for the implementation of the Primary Healthcare Fund and the Emergency, Chronic and Critical Illness Fund, the operationalization of the Dispute Resolution Tribunal, the modalities of empaneling and contracting and settling claims, the development of benefits and tariffs and establishment of a digital platform for the management of the processes and services under the act,” said Kimtai.

The Health PS said that the regulatory impact statement was developed as the two regulations impose significant costs on the community in which they provide for registration of members and change of beneficiaries, manner of making contributions, criteria and procedure for empanelment and contracting of healthcare providers and health facilities.

Kimtai said that the regulations provide measures that the authority shall take to enhance access to safe and quality services offered by healthcare providers and to ensure that the public can access healthcare services from qualified and licensed healthcare providers.

The PS said that the implementation of a system for pooling of resources and risks based on the principles of solidarity, equity and efficiency to guarantee access to health care service for all, the benefits payable and how the payment of claims will be processed.

“The establishment of the Centralised Digital Platform for purposes of claims administration, recording beneficiaries, data and healthcare service delivery data and maintaining healthcare providers’ data and operationalization of the dispute resolution tribunal,” said Kimtai.

The PS said that following public participation and stakeholders’ engagement carried out in February this year with the Ministry receiving written and oral submissions on the two regulations and the regulatory impact assessment with the views collected having been incorporated in the final version.

Kimtai told the Senate that any public office as defined in article 260 of the constitution or any entity performing the function within an agency, health facility or body at both levels of government is required to comply with the regulations.

He said that the regulations will inspire public trust in the public sector in regards to public resources therefore creating accountability and transparency which in turn leads to a positive impact on the quality of healthcare in public health facilities, the reduction of the country’s health burden and on national economic performance.

“Compliance with the regulations will prevent fraud and fictitious claims and will save public resources that will in turn be used to provide improved and comprehensive healthcare benefits to all persons in Kenya,” said Kimtai.

He told the Senate that the Board of the Social Health Authority shall monitor the implementation of the Social Health Insurance Regulations 2024 and the Social Health Insurance (Tribunal Procedure) rules 2024 through annual reports.

Kimtai said the board will carry out regular monitoring and evaluation of specific provisions of the regulations through interaction with the public and stakeholders through public engagement forums and benefit package and tariffs advisory panel provided in Social Health Insurance Regulations 2024.