Various nations, including Kenya, have undertaken ambitious initiatives and implemented legislative frameworks to achieve Universal Health Care (UHC) in recent times. Despite these efforts, legal and political hurdles have hindered the smooth execution of these programs.
In Kenya, President William Ruto’s endorsement of four Health Bills last October aimed to lay the groundwork for an extensive overhaul of the country’s UHC initiative. This led to the establishment of the Social Health Authority (SHA) and the creation of a new public health scheme, the Social Health Insurance Fund, replacing the National Health Insurance Fund (NHIF). However, legal complications arose when the Kenya Medical Practitioners, Pharmacists, and Dentists Union obtained court orders to halt the planned rollout of the new scheme. The government’s appeal to lift the orders is currently pending, with a decision expected on January 19.
Even if the legal obstacles are overcome, the transition from the long-standing NHIF to the new scheme presents challenges. A Harvard University study notes that while Social Health Insurance (SHI) can address specific aspects of a nation’s healthcare challenges, it may not offer a comprehensive solution. Kenyan households are expected to contribute 2.75 percent of their income to the Social Health Insurance Fund, projecting an annual sum of Ksh57 billion ($357.4 million). The transition has caused confusion, particularly affecting high school students who relied on the now-phased-out NHIF-backed EduAfya Medical Scheme.
A poignant case is highlighted in a letter to Kenya’s Ministry of Education, revealing the plight of a student undergoing critical medical treatment in India. The transition period has also impacted key services, with reports of outstanding remittances affecting essential treatments like dialysis. Private medical service providers, feeling the repercussions of the shift, have seen the closure of three dialysis centers in Mombasa due to unpaid amounts owed by NHIF.
Dr. Jonathan Wala, chairperson of the Kenya Renal Association, supports the transition but emphasizes the need for clarity and proper administration during this confusing period. Dr. Davji Atella, Secretary-General of the Kenya Medical Practitioners Pharmacists and Dentists Union, points out concerns in the new legislation, highlighting potential gaps that may leave certain groups, including civil servants, with out-of-pocket expenditures.
In Tanzania, President Samia Suluhu Hassan’s push for the revised National Health Insurance Fund (NHIF) rates faces opposition from private service providers. The Universal Health Coverage (UHC) Bill, signed into law on December 4, 2023, aims to extend health insurance coverage to all citizens. However, disputes over rates between NHIF and private providers have led to a suspension of the new NHIF package.
In Uganda, despite the passage of the national health insurance scheme Bill in March 2021, implementation remains stalled. President Yoweri Museveni’s concerns about the vague implementation framework resulted in the Bill being sent back to parliament for further consideration. The lack of a regulatory framework, disagreements over contributions from the informal sector, and concerns about the burden on the formal sector have further impeded progress.
The critical analysis of these UHC initiatives reveals intricate challenges ranging from legal and political obstacles to practical issues of funding, coverage, and transitioning. As these nations navigate the complex terrain of healthcare reform, addressing these challenges becomes crucial for the successful realization of Universal Health Care.
