Ruto's health agenda in limbo amid court cases

President William Ruto speaks after assenting Universal Health Care Bills at State House, Nairobi, in October 2023. [PCS] The realisation of President William Ruto's health agenda hangs in the balance after courts stopped the implementation of three Acts by the Ministry of Health. This comes even as President Ruto reaffirms that his administration is determined to roll out Universal Health Coverage (UHC). Health Cabinet Secretary Susan Nakhumicha said UHC was to be realised through the enactment of the Primary Health Care Act, Facility Improvement Financing Act, Digital Health Act, and the Social Health Insurance Act. President Ruto assented to the laws on October 19, 2023, at State House. "We do not have a clear briefing on the rollout of UHC. It might not happen because of the court cases, and also, it is a gradual process," said a senior at the Ministry of Health. In a question-and-answer segment with The Standard, Nakhumicha said the laws will anchor UHC, enabling all Kenyans to access quality health services. "Four crucial laws are expected to anchor the implementation of Universal Health Coverage, affirming our commitment to transform healthcare," said the CS. However, Nakhumicha did not clarify the way forward on the matter following the court's move. Furthermore, the CS said the laws will guarantee the provision of quality healthcare to all Kenyans, "unlike the current system that focuses on curative services where patients seek services at high-end hospitals, ignoring those at the lower level". As the ministry geared towards conducting public participation to actualise the changes, Justice Mwita granted orders halting the implementation of the Social Health Insurance Act (SHIA) 2023. The judge said a petition filed by Joseph Aura raises important constitutional and legal questions that deserve urgent and serious consideration. "That in the meantime, a conservatory order is hereby issued restraining the respondents, their agents and or anyone acting on their directives from implementing and or enforcing the Social Health Insurance Act, 2023; the Primary Health Care Act, 2023 and the Digital Health Act, 2023 until February 7, 2024," he ruled. The Primary Healthcare Act governs the Primary Healthcare Act, the Social Health Insurance Act, and the Emergency, Chronic, and Critical Illness Fund. The Social Health Authority (SHA) repealed the National Health Insurance Fund (NHIF) and is also governed by the SHIA. Due to the court case, operations at NHIF are currently shaky. SHA's board of management is also yet to be fully operationalised. President Ruto appointed Dr Timothy Olweny as the chair of the board, alongside Cotu Secretary General Francis Atwoli. Dr Gichuki Kariuki and Jacinta Mutego were also appointed as members of the authority. The CS said changes in the scheme could affect Kenyan Health Maintenance Organisations (HMOs). For instance, increasing the affordability and accessibility of healthcare for low-income individuals may elevate the demand for healthcare services and solutions provided by HMOs and health tech startups in Kenya. Health Cabinet Secretary Susan Nakhumicha. [PCS] According to the SHIA regulations, all Kenyans will be expected to enroll in the medical health scheme, which repealed NHIF. Salaried employees will contribute 2.75 per cent of their gross salary to the kitty, while non-salaried Kenyans will pay 2.75 per cent of their earnings to the medical kitty. No cap The minimum contribution to the kitty is Sh300, but there is no cap on the maximum pay. Amidst the standoff, health workers and experts have criticised the process followed in establishing the Acts, claiming it was not exclusive. Prof XN Iraki, an economist at the University of Nairobi, said the government should go back to the drawing board to ensure the procedural operation of the acts. The Kenya Medical Practitioners and Dentist Union (KMPDU) is among the entities that went to court to stop the implementation of SHIA. The doctors' union raised concerns about the failure to include their submissions and memoranda in the Bills. They also questioned why Kenyans would be denied government services if they do not remit monthly payments to the medical scheme, deeming it unconstitutional. Doctors also suggested the inclusion of a comprehensive medical cover for civil servants, which was not captured in the Acts. Under NHIF, civil servants currently pay Sh1,700 for comprehensive cover. "Public participation was just public manipulation and an academic exercise because all the details we shared were never considered," said KMPDU Secretary General Davji Atellah. Dr Atellah said SHIA might silently privatise the healthcare system, as the laws were hurriedly done, denying Kenyans time for scrutiny. "Why are we directed to get private insurance if SHA will guarantee services to everyone? Out-of-pocket expenses will be higher for Kenyans. This is why we are in court," he said. Alongside the Acts, the ministry has placed much emphasis on Community Health Promoters to handle preventive health. The CS said: "The president flagged off 100,000 community health promoters who were trained, equipped, and deployed in the community as frontline players in the delivery of preventive and promotive healthcare. Community Health Promoters (CHPs) are the veins in running UHC."

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