Why COTU (K) is opposed to the NHIF Amendment Bill.

President Moi left us with a functioning health system and a highly effective education system. It is sad that over the years, these two most important institutions in our society have been downgraded to deplorable and sorry status.  

In 2012, whilst representing workers in the National Hospital Insurance Fund (NHIF) board, I strongly opposed the implementation of the new membership contribution rates with a view that as constituted then, the NHIF did not have the capacity to manage such huge funds coming with increased contributions and equally, the then Cabinet Secretary for Health was all over the NHIF micro-managing the Fund as if was just a department under the Ministry.

At the same time I cited that prior to the implementation of the new rates, NHIF did not engage COTU-K as the umbrella workers body in the country in order to get their views.  

In 2013, I made good my threat that I would resign if the government approved the new fees payable to NHIF without due diligence and accountable management. Time has, indeed, absolved me. The NHIF fund has since been struggling to meet its obligations to workers. Workers have lost millions under the fund due to a lack of accountability. This Fund, meant to assist workers to cover their medical expenses, has over time been converted into a cash cow where politicians exploit these funds for personal and luxuries use.

Moreover, card-holding members of NHIF have been, times without number, denied services by hospitals considering NHIF has not been remitting payments to hospitals for services offered even though such members have been religiously contributing to the fund.   

Just recently, the Majority Leader of the National Assembly, Hon. Amos Kimunya, introduced the National Hospital Insurance Fund (Amendment) Bill, 2021 into the floor of parliament that seeks to not only amend NHIF Act No. 9 of 1998 but also disband, in total, the NHIF as we know it.

COTU and all its 45 Affiliate Unions, and by extension the over 4 million COTU members, strongly oppose the amendments as contained in the NHIF amendment bill, in totality. Here’s why.

NHIF was established by workers and formalized under Cap 255 of the Laws of Kenya in 1966 as a department in the Ministry of Health to provide health insurance exclusively for those in formal employment. Therefore, the core mandate of the fund is, and remains, to provide medical insurance cover to all its members (workers with an income) and their declared dependents; spouse and children.

On the contrary, the amendment bill seeks to change NHIF, as we know it, from a fund to a scheme and by and large changing the mandate and objective of the NHIF as it were previously. In essence, this amendment bill will disband NHIF and bring up an amorphous body with a new mandate and new objectives. This is against the wish of Kenyan workers who are the contributing members of NHIF.

This amendment mirrors the detested Affordable Care Act in the US which has been very disruptive to the health benefits of American workers and failed tremendously in times of Covid-19. Very soon, because of this bill, employers will stop providing health coverage to their employees just like in the US. On the contrary, NHIF, as it is, has the capability of mirroring the National Health Service (NHS) in the UK. This explains why the UK has been able to contain the adverse effects of Covid-19 save for leadership. 

It is without question that the rationale behind the initiators and supporters of this Bill is full of ulterior motives considering the mandate of the NHIF should not be maximizing on the amounts they are collecting but it should be to effectively use the collected amounts. What is it that the Bill want NHIF to do with the money they are seeking to collect from any Kenyan above the age of 18 years that they have been unable to do with the money contributed by the over 8 million NHIF contributing members?

The bill also seeks to coerce Kenyans to contribute towards NHIF without assuring them reliable services and transparency in the fund. NHIF should not be obsessed with collecting more money but using the fund collected effectively. It is also wrong to use laws to coerced Kenyans to contribute to any scheme.

Additionally, the management of NHIF is yet to conduct any proper consultation and engagement to get views from both workers and employers as required by Convention 144 of the ILO on social dialogue. More seriously, COTU (K) is reliably informed that even the NHIF board did not have a meeting that discussed the NHIF amendment bill.  

It is, therefore, our position that NHIF should emphasize on accountability of the fund and the effective use of the same. We also demand that the government should stop any move aimed at interfering with the structure and the objective of NHIF and that if the government is in dire need of a scheme to offer universal health to the Kenyan citizenry, then let the Government create its separate healthcare scheme to provide affordable care to be used by the indigent and vulnerable persons.

Any attempts to disband the NHIF, as envisaged in the proposed amendments, will leave workers under the umbrella of COTU-K  with no other option but to move to court a seek order to annul any such attempts.  

 

Dr. Francis Atwoli NOM (DZA), CBS, EBS, MBS.

Secretary General

Central Organization of Trade Unions (Kenya)