New health legislation a game changer in Kenya’s health security

Kenyans now expect to access quality healthcare in an improved, efficient, affordable and non-discriminatory manner.

This follows the signing of four revolutionary and progressive Universal Health Coverage Act s into Acts on Thursday 19^th October 2023 by President William Ruto.

These are The Primary Health Care Act, 2023, the Digital Health Act, 2023, the Facility Improvement Financing Act, 2023 and the Social Health Insurance Act, 2023.

The laws are expected to provide the necessary legal and institutional framework for the successful rollout of Universal Health Coverage and by that ensure Health security for all.

However, the game changer isThe Facility Improvement Financing Act 2023 which provides health facilities with financial independence to manage revenue collected through user fees, insurance payments, and other own sources. Currently, revenue from most health facilities across the country is consolidated in the County Own Source Revenue (OSR) Fund.

Hence, facilities depend entirely on in-kind budgetary support from the county budget for salaries, stipends, medicines, equipment, infrastructure and consumables.

This has denied facilities the resources and an independent option to respond to local, own and emerging priorities since decision-making is centralized at the county level.

The FIF Act 2023 as established focuses on ensuring revenues collected at the facility level are retained, planned and used by the same public health facilities/Units for immediate operating costs (for instance, buying out-of-stock and in-demand medicines and covering maintenance, utilities or local Act s and expenses as needed).

The fund aims to provide for an efficient, secure and accountable mechanism for the collection, retention and management of revenue derived from health services rendered at the facility.

The key to this fund is that facilities now can open their bank accounts and have their funds there as supplement to their needs and to the allocation by the county government but not as a substitute to allocation. The funds covered here include user fees, charges and reimbursement for insurance firms and other entities.

Monies appropriated by county government from equitable share as well as conditional grants and donations is also earmarked at FIF in the act.

To ensure effective implementation, the cabinet secretary is required to develop policy guidelines on revenue management, establish a repository for financial information, analyses the data collected and provide feedback that would assist national and county governments monitor performance and ensure effective implementation.

The planning for the FIF must be integrated within the county planning and budgeting process to ensure prudent planning but also its required that in involves the community members in the governance structure of the fund.

The act also established the County Health Management teams and mandates them to coordinate the interpretation and implementation of the fund, support sub county and facility teams prepare their annual and quarterly plans as submitted by the Health Facility Management committees.

To ensure accountability, the Act provides that the chief officer is the accounting officer and will be issuing authority to incur expenses to the medical superintendent for hospitals and to the facility in charge for health centers and dispensaries.

For reporting, the funds will be managed by the public health facility and thus the facility is expected to collate and report on all revenue collected and ensure its reflected in the County.

The Facility Improvement Financing Act addresses underfunding in public health facilities, while the Digital Health Act streamlines technology adoption to enhance data sharing and resource utilization. The Emergency, Chronic and Critical Illness Fund will handle emergency and chronic illness costs once social health insurance is depleted.

The Four Acts have come into force at the same time, Thus the need for a clear integration between them. Creation of the health management committees immediately with community members is key to ensure accountability of the funds. Opening of facility bank accounts is a key first step and directing the fund there will require modern mechanism including pay bills or card system to minimize cash payments and loss of funds.

Finally, aligning these legislations would go a long way in guiding the development of detailed implementation guidelines and their eventual commencement, improving the chances of success for these reforms to accelerate Kenya’s progress towards UHC and health security.

There will be need for closer and consistent monitoring of implementation of these acts from commencement especially seeing that funding will both be at the national and county levels.

There will be need for capacity building of Primary Health Networks as well as awareness to the general public on the changes occasioned by these Acts and their role in ensuring health security in Kenya is owned by Kenyans and no one is left behind.

There is needed uniform guidelines to all counties especially in implementation of PHC to ensure standard application across the Country.

The writer is the founder and director of Pathways Policy Institute, Nanyuki.