There will always be resistance to change

DR CHARLES MARINGO

The NHIF saga has undoubtedly been the most talked about public interest matter in the recent past. Both the print and the electronic media have given the matter extensive coverage over the past few weeks since the infamous or so it seems, move by the NHIF board to gazette the new tariffs.

The Central Organisation of Trade Unions and the Federation of Kenya Employers as expected have been at the forefront in a spirited campaign to halt implementation of the new tariffs and to show they mean business; they went a step further and instituted a court case against the NHIF. To the general public this may just be another one of those tides that come along every so often and is bound to pass but to me and some people I suppose, I see these events to be of serious significance and there is need to look at the matter from all angles to demystify the significance of these events and the timing.

In recent times and in our quest to get a new Constitution we experienced some hurdles emanating substantially from a section of the political class and the clergy who seemed to have some interests which were at variance with a majority of the voters if the results of the referendum are anything to go by.

Unlike in most cases where many a conflict are borne out of the failure of one of the parties to admit the ingenuity of being wrong; in political tussles both parties may actually be right and much that may be of substance may be said on both sides. It is for the electorate to decide which side seems more consonant with its needs to make the appropriate decision.

Back to the matter at hand, it has been argued that the new rates of NHIF contributions are unjustified and would only serve to add an additional burden to the taxpayer. It is a fact that citizens have never welcomed any prospect of increased taxation. In fact, if the subject were to be put to a forum many would be at variance as to what actually constitutes a tolerable tax level.

It is also a fact that for a government to meet its obligations, it needs resources and such resources can only be obtained from the citizens.

Collectivism is a feature that is common to all societies the world over in any quest to implement meaningful change. Our pre independence fathers had this tradition deeply entrenched in their minds and it was passed on from generation to generation.

Whenever there was scarcity of resources or events afflicting the society in general; society came together to foster solutions that sought to ensure greater unity and harmony for the society as opposed to conflict.

Interdependence and sharing was a feature that was evident in all African societies. Every individual had the responsibility to be his brother’s keeper and the duty to contribute to society for the common good was in every individual’s psyche. The founders of our nation sought to ensure continuity of these values by seeking to peg the country’s development aspirations on the concepts and philosophy of African socialism.

Although in their aspiration they may have fallen by the wayside and adopted a more capitalist individualist approach to social development, these deeply entrenched values still ring aloud in our minds.

Reforms in this country have been hard to come by. Healthcare reforms, the issue at hand has not escaped the adversity of the anti reformers. Despite statistics showing that there is a high incidence of unequal distribution of social services in general resulting in exclusion of certain population sectors, the anti reform crusade has largely taken root and has proven to be a real hurdle.

A recent International Finance Corporation/World Bank report indicated that people in sub Saharan Africa have the worst health on average in the world. The region has 11 percent of the world’s population and 24 percent of the global disease burden and lacks the infrastructure to provide even basic healthcare to its people.

The IFC report, The Business of health in Africa: partnering with the private sector to improve people’s lives says spending on health in Sub Saharan Africa is set to double over the next five years. Somebody has to shoulder these additional costs. The last time the NHIF rates were revised in Kenya if my recollection serves me right was in 1989. At the time and throughout this period until recently the NHIF has largely been ineffective in improving accessibility to healthcare for the masses.

The small resource base could only carter for Hospital bed admission costs which in the grand spectrum account for very little of the overall cost of healthcare. The NHIF has since launched an ambitious benefits package that almost guarantees unlimited outpatient and substantial inpatient coverage to its contributors. Individuals will be required to contribute at least Sh150 and at most Sh2,000 to be guaranteed unlimited outpatient coverage for the individual and family.

It is now partnering with stakeholders such as the care givers to ensure greater access through accreditation. Significant milestones if I were to be asked, for which the NHIF should be lauded. I still insist someone has to shoulder this burden and it has to be Kenyans. The argument of increased taxation should be looked at afresh.

Taxation as a means for sourcing and consolidating revenue for government expenditure has been practiced for generations. It was introduced to us during colonialism and is here with us to date. The mechanisms involved in government budgeting and speculating on revenue for public expenditure are a feature of modern day economies.

Government revenue expenditure forecasts are determined by economists employed by government. There are no guarantees revenue allocations for specific objectives actually get to be applied for earmarked projects. We are yet to attain that level of efficiency and probity in public resource management. To constitute a fund such as the NHIF that provides for a direct channeling of earmarked funds to its specific resource fund directly from the contributors serves to lessen the burden and improbity that government budgeting and resource disbursement may present.

The problem with the current Kenyan society is that both the political class and civil service have become so institutionalized in maintaining the status quo out of fear of change and its implications to their status and well being as individuals that they have become recalcitrant to change.

The NHIF is a statutory body that only seeks to fulfill its statutory mandate. It does not act suo moto (on its own). All its stakeholders are meant to participate in decision making. Concerted efforts were made by the legislature to ensure that all possible stakeholders are included in decision making. This is the era of collective policy formulation and decision making in affairs of government.

This is our moment to venture into the unknown. Change and chance are one in our national mood.

(The writer is s public health specialist - charles.maringo@gmail.com)