MPs query plan for each spouse to pay for SHIF

Health CS Susan Nakhumicha (right), NHIF CEO Elijah Wachira and KMPDC CEO David Kariuki before the National Assembly Department on Health and Senate Committees. [Elvis Ogina, Standard]

Questions have emerged over a requirement for each spouse to pay towards the new medical scheme.

In the Social Health Insurance Regulations, 2024, the contributor will pay separately for each individual spouse, under the Social Health Insurance Fund (SHIF).

This requirement was subject of heated debate during scrutiny of the Social Health Insurance Act, 2023 conducted by the National Assembly Department on Health and Senate Committees.

The MPs demanded clarity from health officials as to why payment was to be done by individual spouse. Senate Health Committee chairman Jackson Mandago asked why the ministry used spouse, instead of saying an extra wife.

"What we need to say is there is no extra spouse, but rather individuals, will contribute for every spouse," said Mandago.

The Uasin Gishu Senator added: "The whole point is this contribution. We need to get the right language on the act and the regulations."

Seme MP James Nyikal demanded an explanation of the definition of a household and a spouse. "In terms of polygamy, let us go for the definition of household and recognise polygamy and say every wife is a household on her own," said Nyikal.

Dr Abdi Mohammed, an official from SHA said contribution to the second spouse should be done, as it has been under the repealed National Health Insurance Fund (NHIF).

"Benefits and contributions march. Each of you look at it this way, you still pay school fees for children sired with different wives," said Mohammed, in defence of why a contributor should pay separately.

Mohammed further clarified that benefits can only go in line with the contribution to be able to pay for the benefits.

"Contributions are based on household response. Someone with two wives has only one household," Mohammed told the House team.

The committee further asked for an explanation of a household as listed in the new health regulations.

According to the Social Health Insurance Act, 2023, a household is defined as a social unit comprising of an eligible contributor, whether contributing by self or paid for, and their beneficiaries, or who share the same socio-economic needs associated with consumption and production. In the new medical scheme, a contributor is expected to pay for each individual spouse, in cases where a contributor has more than one spouse.

But to benefit from the scheme, the contributor will be expected to provide proof of marriage documents for each individual spouse.

"...in case of a spouse of the contributor, a copy of the identity document of the spouse and copy of proof of marriage," reads a section of the regulations.

Initially, the marriage certificate had been placed as a document of approval. However, during public participation, Kenyans were of the opinion that a contributor should only produce a document to show proof of marriage, instead of a marriage certificate as earlier provided.

Presidential Health Advisor Dr Daniel Mwai acknowledged the importance of having the law looked into keenly, to avoid having it as discriminatory. "Within the Act, there is a provision for an extra spouse to pay as an individual. The how of doing it is what we are discussing this morning," said Mwai.

Mwai told the team that it is worrying that Kenyans expected more from NHIF, than the provision of resources that were given. He explained why it is important to have each individual spouse contribute to the scheme.

Nyeri Town MP Duncan Mathenge also sought answers on whether the new scheme will cater for adopted children. Traditionally, he said in most communities, children, more so orphans are left under caregivers, who are usually their grandparents, or closer relatives.