No special SHA covers for civil servants, ministry clarifies

The Ministry of Health has maintained that there are no special schemes for civil servants under the Social Health Authority (SHA).

This is even as teachers, police and prison officers are onboarded to the Mwalimu and Usalama covers, under the social health scheme.

Civil servants, according to SHA Chief Executive Officer (CEO) Dr Mercy Mwangangi, will instead access care through the Public Officers Medical Scheme Fund (POMSF) arrangements.

Dr Mwangangi told The Standard that there is a distinction between SHA’s national role and the employer-sponsored schemes.

The ministry has noted a distinction between SHA’s national role and employer-sponsored schemes.

The CEO explained that the SHA reform objective undertaken by Taifa Care is the opposite of the defunct National Hospital Insurance Fund (NHIF) era fragmentation.

SHA model, she said, is aimed at moving the country toward a more equitable, transparent and nationally structured health financing model.

This is aimed at attaining Universal Health Coverage (UHC) for all Kenyans, regardless of their financial status.

"The Ministry is aware that separate employer-linked arrangements for some public sector groups can create public concern and confusion," Dr Mwangangi told The Standard.

Initially, the defunct NHIF had schemes for civil servants, including the police and prison officers.

The employees were enjoying cover under compressive medical cover, paying a monthly premium of Sh1,700.

However, with the enactment of SHA, all the benefits were folded as it was believed to cater for civil servants more, unlike individuals in informal settlements.

“On an appointed day, the Fund shall not provide enhanced benefits schemes and packages,” reads Section 5 (1) of the SHI Act.

But according to the SHA boss, the employees remain entitled to their negotiated healthcare benefits under the Public Officers Medical Scheme Fund (POMSF).

The cover, she said, is anchored within the broader SHA framework.

"That is why the Government has been clarifying the distinction between SHA’s national role and employer-sponsored schemes, while continuing to push for a smoother, more coherent system for all Kenyans," added Dr Mwangangi.

Under NHIF, medical cover was enhanced, unlike that of the ordinary contributor.

Teachers, police and other civil servants, because of their unions, negotiated for their medical allowances so that they can buy a better medical cover.

The Rural and Urban Private Hospitals Association (RUPHA) argued that providing the employees with a separate cover from a basic one is illegal.

This is even as experts observe that allowing civil servants to have preference for employer-sponsored schemes will kill the goal of UHC and equality in healthcare.

Beatrice Kairu, health economist and policy expert, feared that private hospitals would target civil servants and shun away the vulnerable.

“It is worrying that we are most likely to see providers start preferring civil servants, unlike other Kenyans. This will introduce inequality,” observed Kairu.

Legally, Lishenga said SHA has no mandate to come up with enhanced cover, once you deduct 2.75 per cent from their salaries.

The mandate of the social cover he maintains is to provide basic cover.

“The call of SHA was to actualise UHC for all Kenyans. SHA was not to create classes of Kenyans, because what they are doing is creating classes, someone deciding to get to SHA, and creating their own benefits," said Lishenga.

Kairu maintained that, though having an enhanced medical scheme is wrong, because it is against the SHI Act, practicability, and money that was being paid to private entities, gets to the government.

According to Kairu, the defunct NHIF created a scheme to cater for civil servants, and instead of the government buying from a private insurance, which was more expensive.

The aim of the social cover, according to its establishment, was to abolish schemes, but cover more Kenyans, pegged on 2.75 per cent earnings.

Ideally, Kairu observed that a cap of 2.75 per cent means everyone, including the vulnerable who are paying Sh300, should get, for instance, a C-Section, like someone paying a higher amount.

“SHA has leeway to create schemes for people who are willing to pay, but it is not a good concept, because vulnerable ones are retained at basic services,” said Kairu.

Kairu maintained that even as public employees are onboarded to SHA, vulnerable Kenyans should still be allowed to access care and services they deserve, without any form of discrimination or inequity.

Lishenga explained that POFMF was created by a regulation, approved by the National Treasury, a regulation that cannot supersede an Act of Parliament.

Their unions should have challenged, so that they have control of their own medical scheme and taken it to the market, for them to get the most competitive cover. They have denied teachers the advantage of an open market.

“Benefits that teachers and other civil servants are enjoying are limited by the Act. The benefits were gazetted, and SHA cannot be compelled to provide more,” said Lishenga.

He added, “SHA only provides a basic cover, while they are paying double, including the 2.75 per cent deductions, and the medical allowances”.

“Teachers want a private room or surgery at a particular time, but under the SHA, such benefits are not applicable. They get cover like anybody else paying for the cover,” the official said.

Ministry of Health should admit that SHA doesn’t offer enhanced cover, but teachers and police officers, including police officers, have an enhanced benefit.

Lishenga maintained that SHA only offers basic cover.

“Teachers and police expect an enhanced cover because they are paying double, and they negotiated through bargaining.”

“The law prohibits SHA from offering anything enhanced. The law prohibits that, so SHA will be breaking the law. Nothing can be clarified under the law,” said Lishenga.

Having teachers, police officers and prison officers on board on SHA, according to the RUPHA boss, is wrong.

Evance Ndong, a constitutional lawyer, said the problem with SHA is that it was not well thought out during transition.

Because of this, laws and regulations continue to be worked on to operationalise it, and whenever such a move happens, there is an overriding of the Act.

“Regulations cannot override the right principal Act, as we were thinking of migration, we ought to have thought of how transition would affect them, we do not reform one side and leave one side,” said Ndong.

He noted that regulations should inject life into an Act, and not vice versa.

Nevertheless, experts have asked the government to ensure public facilities are working optimally to be on par with private ones.

The majority of public hospitals across the country, and more so in county facilities, grapple with a lack of personnel and medical commodities.