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{
"id": 1521212,
"url": "https://info.mzalendo.com/api/v0.1/hansard/entries/1521212/?format=api",
"text_counter": 93,
"type": "speech",
"speaker_name": "Endebess, UDA",
"speaker_title": "Hon. (Dr) Robert Pukose",
"speaker": null,
"content": "Further, SHA is actively implementing the following activities to build upon and improve its performance: 1. Data-driven Insights, 2. Incentive programs, 3. Payment systems, 4. Transparency and accountability, 5. Strengthened community engagement, and 6. Long-term financial planning where they develop sustainable financial models that account for population growth, healthcare cost inflation and economic fluctuations. On number Three, the requirement for out-of-pocket payments and its impact on access to healthcare. While SHA aims to reduce out-of-pocket healthcare costs, the Committee noted concerns about instances where patients still incur expenses. To mitigate this, the following activities are being undertaken: 1. Creating awareness and sensitising the public on the applicable benefits and tariffs for informed decision-making in the choice of facility. 2. Reviewing the benefit package and tariffs in collaboration with the benefit package and tariff advisory panel. 3. SHA will submit to Parliament a list of healthcare facilities where patients on SHIF contributions will receive a comprehensive payment without co-payment and with co-payment. Hon. Speaker, on the difference between SHA and Taifa Care, Taifa Care is a Kenyan government initiative aimed at achieving Universal Healthcare Coverage (UHC), ensuring that all citizens access equitable, affordable and quality healthcare services. The initiative focuses on four key pillars: sustainability of healthcare financing, digitisation of health systems, enhancing human resources for health and security of health products and technologies. This programme encompasses a series of legislative measures designed to strengthen the healthcare system and reduce financial barriers for all Kenyans. The key legislative components of Taifa Care are: 1. Primary HealthCare Act, 2. Social Health Insurance Act, 3. Digital Health Act, 4. Facility Improvement Fund (FIF) as enacted by this House. On the other hand, the Social Health Authority was established under the SHIF Act, 2023, with a core mandate of pooling financial resources, risks and strategic purchasing of healthcare services on behalf of the Kenyan people towards strengthening health financing for Universal Health Coverage (UHC) through the management of three funds namely: 1. Primary Healthcare Fund (PHCF) 2. Social Health Insurance Fund (SHIF) 3. Emergency, Chronic, and Critical Illness Fund (ECCIF). On the status of debts inherited by SHA from the National Health Insurance Fund (NHIF) and plans in place to clear them to ensure seamless service delivery, Hon. Speaker, this is a very important fact because the defunct NHIF owes healthcare providers an estimated Ksh30.9 billion. Additionally, NHIF owes co-insurers Ksh8.137 billion for civil servants' WIBA claims and a further Ksh3.927 billion in accumulated WIBA claims before April 2021. NHIF also has outstanding premium receivables totalling Ksh25.5 billion across various government-funded schemes. These include the civil service medical cover, Linda Mama programme and indigent support as annexed. These delayed payments have disrupted service provision, putting pressure on both public and private health institutions. SHA has been The electronic version of the Official Hansard Report is for information purposesonly. A certified version of this Report can be obtained from the Hansard Editor."
},
{
"id": 1521213,
"url": "https://info.mzalendo.com/api/v0.1/hansard/entries/1521213/?format=api",
"text_counter": 94,
"type": "speech",
"speaker_name": "Endebess, UDA",
"speaker_title": "Hon. (Dr) Robert Pukose",
"speaker": null,
"content": "engaging the various MDAs to recover the outstanding debts owed to NHIF and facilitate payments of debts owed to providers by SHA. Concerning NHIF benefits that were made more favourable compared to SHA despite SHA collecting higher contributions, SHA benefits have a broader scope of coverage compared to NHIF benefits. The contribution design for SHA is based on the solitary principle, which states that all persons contribute according to their ability to pay and receive similar benefits and tariffs. This is mainly due to SHA's potential for larger pooled resources and risks, enabling broader coverage and enhanced access to healthcare services. The SHA benefits ensure access to the full spectrum of healthcare services, from prevention and promotion to curative, rehabilitative, and palliative care."
},
{
"id": 1521214,
"url": "https://info.mzalendo.com/api/v0.1/hansard/entries/1521214/?format=api",
"text_counter": 95,
"type": "speech",
"speaker_name": "Endebess, UDA",
"speaker_title": "Hon. (Dr) Robert Pukose",
"speaker": null,
"content": "Further, SHA benefits are equitable, affordable, and accessible to all Kenyans, which aligns with Article 43 of the Constitution. Regarding the comparison between NHIF and SHA benefits, we have an annexe, which I will table here. Hon. Speaker, on the status of the NHIF staff and whether they will be absorbed by the SHA, despite Paragraph 1 of the SHIF Act, the Social Health Authority Board, established under Section 4 of the Act, shall competitively recruit and appoint staff under Section 17 of the Act, subject to the approved staff establishment and on-site terms and conditions of service as may be determined by the Board. Notwithstanding the provisions of that paragraph, staff are eligible to apply for the positions advertised by the Authority. They may be considered for appointment where they are suitably qualified for advertised positions. Despite the provisions of paragraphs 2 and 3, the Authority will review the qualifications of all the staff of the Fund. It shall give priority to the staff of the Fund who are found to be suitably qualified for the positions in the approved staff establishment. The staff of the Fund not appointed to the Authority under Paragraph 2 of the Act may exercise their options to either retire from public service or be redeployed within the public service. On the status update of the NHIF staff transition, the SHA Board has since sought the advisory of both the Attorney-General and the Public Service Commission (PSC) on staff transition. On 21st November 2024, all 1,737 staff of the defunct NHIF were taken over by the Public Service Commission and subsequently deployed to the SHA for six months or until the SHA completes recruitment, whichever comes first. The SHA Board has since reviewed the human resource instruments and submitted them to the Public Service Commission for approval. Suitability tests are scheduled to commence before the end of February 2025. On concerns that data captured by the SHA is inadequate, frustrating patients seeking treatment, and on the measures being put in place to ensure data accuracy, the data captured by the SHA is adequate to ensure service provision. However, patients face challenges and measures to address them are ongoing. Further, the Authority noted that some Kenyans do not complete the registration process, especially those that only register through the USSD code *147# channel. Those Kenyans have not gone through the means testing process that enables them to make payments under the SHIF and are not eligible for the SHIF services in Level 4, 5 and 6 hospitals. On the issue of lack of medicines in hospitals where patients are supposed to receive treatment but are not given the prescribed medication, the Ministry appreciates the challenges of procuring health products and technologies. The Kenya Medical Supplies Authority (KEMSA) business model was disrupted from 2019 to 2022 due to the impact of COVID-19 on the production of health products and technologies. The procurement of COVID-19 Health Product Declarations (HPDs) during the 2019/2020 period significantly impaired the Authority's cash flow. Additionally, as detailed below, the Authority has been burdened by significant receivables amounting to more than Ksh6 billion. As such, the organisation's sustainability model has been facing various challenges, including inadequate financing to procure HPDs, with a funding gap of Ksh5 billion, and debt repayments, among them being The electronic version of the Official Hansard Report is for information purposesonly. A certified version of this Report can be obtained from the Hansard Editor."
},
{
"id": 1521215,
"url": "https://info.mzalendo.com/api/v0.1/hansard/entries/1521215/?format=api",
"text_counter": 96,
"type": "speech",
"speaker_name": "Endebess, UDA",
"speaker_title": "Hon. (Dr) Robert Pukose",
"speaker": null,
"content": "the county debts amounting to Ksh3.5 billion, with more than Ksh2.7 billion being over 90 days old. The counties work with KEMSA to generate forecasts on what should be stocked at the Authority. However, the counties opt to buy elsewhere when it comes to procurement. The Committee will hold a meeting with KEMSA to develop a way forward. We intend to improve HPD availability by recapitalising KEMSA with a budget allocation of up to Ksh5 billion to replenish deteriorating capital and break the various cycles of debt, pending bills, and low order fill rates. The National Treasury has so far allocated Ksh1.5 billion to be factored in the Second Supplementary Budget. That will boost the availability of essential health products and technologies for Universal Health Coverage. Additionally, the Authority is engaging the county governments to pay long-term outstanding bills currently standing at Ksh3.5 billion. In a report on the public participation conducted before and after the roll-out of the SHA, the Ministry placed advertisements in the print media on 28th November 2023, and the regulations were also developed and posted on official websites. The analysis of the views and submissions expressed during the consultations and engagements indicated that the principal regulations, particularly the benefits package in the principal regulations, amended regulations and tariffs for health services will facilitate the realisation of Universal Health Coverage in the country. The principal regulations have provided a clear framework for reviewing the tariffs for healthcare services and benefits packages offered by the Social Health Authority under the Primary Health Care Fund, the Social Health Insurance Fund and the Emergency, Chronic and Critical Illness Fund. On concerns that the SHA branches cannot adequately address customer challenges at the local level due to connectivity and system hitches, the system availability currently stands at 98.2 per cent as of 7th February 2025 at 12.38 a.m. Digital health agencies are working hard to stabilise the system to meet the targeted 99.99 per cent availability. The system configuration is ongoing to address those challenges, with a completion target by the end of February 2025. The agency is also fast-tracking the integration of existing hospital management information systems and claims management systems to further enhance efficiency in operations. That will improve system availability and experience for Kenyans. On concerns regarding poor public communication, the SHA is employing the following strategies: 1. Collaboration and partnership with other Ministries, Departments, and Agencies (MDAs) to carry out public education and awareness. 2. Enhanced use of soft, as opposed to hard information education and communication materials. 3. Leveraging the SHA branches' network and Huduma Centres for service delivery. 4. Partnership and support from development partners. 5. Working closely with grassroots leaders, including the National Government Administration Officers (NGAOs), for enhanced communication, awareness and registration. 6. Use of alternative media, including social media, to reach a wide spectrum of the population. Regarding inadequate service delivery under the SHA, I will table the SHA benefits package and tariffs so that Members can go through them. On strategies that the Ministry is implementing to ensure disadvantaged groups are fully covered under the SHA, identification of indigent populations through proxy means testing as required by the SHA Regulation 19 is ongoing. The government budget allocation towards that endeavour will also be a boost to ensure that indigent populations are well cared for. The electronic version of the Official Hansard Report is for information purposesonly. A certified version of this Report can be obtained from the Hansard Editor."
},
{
"id": 1521216,
"url": "https://info.mzalendo.com/api/v0.1/hansard/entries/1521216/?format=api",
"text_counter": 97,
"type": "speech",
"speaker_name": "Endebess, UDA",
"speaker_title": "Hon. (Dr) Robert Pukose",
"speaker": null,
"content": "Coverage for pregnant mothers and teenage pregnancies falls under the Linda Mama Programme, which is still ongoing and ensures pregnant mothers, including teenage mothers, receive full health coverage. That coverage is effected upon first contact at the facility. For mothers due for delivery who have not paid the SHA premiums, the Linda Mama Programme automatically identifies them and pays their annual premiums, covering the entire household. The State Department for Medical Services is currently responsible for payments of the premiums. On concerns that despite the high premiums, patients in need of services are being turned away by hospitals, several issues have been identified where members, despite having made payments, are deemed ineligible by healthcare providers. This includes incomplete payment records in the SHA database, absence of corresponding payment reference numbers, payments made via real-time cross-settlements, and RDGs and Electronic Funds Transfer (EFT) methods sometimes lacking corresponding Payment Registration Numbers (PRNs). That omission prevents the automatic updating of individual member amounts, leading to service ineligibility. On payment variances and discrepancies between PRN amounts and bank payments, when the amount indicated on a PRN differs from the actual amount paid, the system cannot auto-update the member’s amount. That scenario necessitates manual intervention. Employers are required to upload detailed payment information, including employees’ names and corresponding amounts, into the SHA system before remitting payment. We have erroneous national identification numbers, incorrect data entry, and cancellation of payment registration numbers by employers. This also has an impact on employee eligibility. We also have unprocessed payments. To mitigate this, we have the empowerment of branch offices, member self-service applications, employer notifications, employer sensitisation initiatives, the development of information materials, and simplified registration channels where we have accessible registration methods. The accessible registration methods include USSD code-assisted registration, an online portal, and physical locations where SHA branches and Huduma Centres provide in-person registration services."
},
{
"id": 1521217,
"url": "https://info.mzalendo.com/api/v0.1/hansard/entries/1521217/?format=api",
"text_counter": 98,
"type": "speech",
"speaker_name": "Hon. Speaker",
"speaker_title": "",
"speaker": null,
"content": "How much more time do you have to go?"
},
{
"id": 1521218,
"url": "https://info.mzalendo.com/api/v0.1/hansard/entries/1521218/?format=api",
"text_counter": 99,
"type": "speech",
"speaker_name": "Endebess, UDA",
"speaker_title": "Hon. (Dr) Robert Pukose",
"speaker": null,
"content": " Two minutes, Hon. Speaker."
},
{
"id": 1521219,
"url": "https://info.mzalendo.com/api/v0.1/hansard/entries/1521219/?format=api",
"text_counter": 100,
"type": "speech",
"speaker_name": "Hon. Speaker",
"speaker_title": "",
"speaker": null,
"content": "Good."
},
{
"id": 1521220,
"url": "https://info.mzalendo.com/api/v0.1/hansard/entries/1521220/?format=api",
"text_counter": 101,
"type": "speech",
"speaker_name": "Endebess, UDA",
"speaker_title": "Hon. (Dr) Robert Pukose",
"speaker": null,
"content": " Integrating with the national registration bureau is for data verification and cross-referencing. There was an issue with the measures that the Ministry is taking to ensure the informal sector and indigent populations are registered under SHA. Some of the challenges facing informal sector registration of members into SHA include low awareness and sensitisation, irregular and unstable income, and lack of formal identification. What is SHA doing to mitigate this? We are doing mass awareness and sensitisation, utilising community health promoters, vernacular radio stations, crossroad roadshows, and TV campaigns to reach informal workers in their local languages. This ensures a widespread understanding of SHIF benefits and encourages voluntary enrolment. The flexible payment method allows informal workers to contribute through monthly mobile money payments like M-Pesa. That makes it easier for them to afford and maintain coverage despite irregular incomes. There is integration with SACCOs and Chama, partnerships with county governments, and engagement with informal sector associations such as the Bodaboda Association of Kenya. We also utilise insurance premium financing, where we collaborate with microfinance institutions and Government funds, like the Hustler Fund, to provide credit facilities for premium payment, thus ensuring affordability and reducing dropout rates. The electronic version of the Official Hansard Report is for information purposesonly. A certified version of this Report can be obtained from the Hansard Editor."
},
{
"id": 1521221,
"url": "https://info.mzalendo.com/api/v0.1/hansard/entries/1521221/?format=api",
"text_counter": 102,
"type": "speech",
"speaker_name": "Endebess, UDA",
"speaker_title": "Hon. (Dr) Robert Pukose",
"speaker": null,
"content": "We have targeted communication where we develop specific messages for the elderly, poor and vulnerable groups using simplified content and trusted community influencers to drive awareness and registration. We also encourage NG-CDF budgetary allocations. We advocate allocating NG-CDF funds to sponsor SHIF premiums for vulnerable groups. This is where Members come in, ensuring equitable access to healthcare. This is in addition to public-private partnerships where we partner with microfinance institutions, donor agencies like AMPATH and UNHCR, and NGOs to extend healthcare loans to pay premiums. Hon. Speaker, the Committee has also made recommendations. We shall be engaging the Ministry of Health and SHA in a retreat to look at debts owed to the defunct NHIF. Further, we will engage them on more issues. The means testing tool used in the informal sector needs to be reviewed to improve its reliability and accuracy through actual field visits, not online. Quality health assurance officers will verify health services with technical knowledge to detect and eliminate fraud. The SHA has inadequate feasibility capacity to confirm if contracted facilities render the services they claim. We will also look at the benefits package under the Primary Healthcare Fund, which needs to be enhanced. The State Department for Social Protection will leverage data provided by the SHA to avoid subjecting indigents to fresh means testing. Hon. Speaker, the PSC has approved a SHA staff establishment of 815. In recruiting staff, the SHA Board should follow the law per the transition clauses in the SHA Act of 2020 and SHIF Act of 2020. All former NHIF officers not employed under SHA will be deployed within the Public Service Commission or exercise the right to retire under the Act. Thank you, Hon. Speaker."
}
]
}