New legislation a game changer in 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 Acts on October 19 by President William Ruto.

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

The laws are expected to provide necessary legal and institutional framework for the successful rollout of Universal Health Coverage (UHC) and ensure health security for all.

However, game changer is the Facility Improvement Financing (FIF) 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 is consolidated in the County Own Source Revenue Fund. Hence, facilities depend entirely on in-kind budgetary support from 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.

The FIF Act focuses on ensuring revenues collected at the facility 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 Acts 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.

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 county government but not as a substitute to allocation.

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 FIF must be integrated within the county planning and budgeting process to ensure prudent planning.

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 facility in charge of health centres and dispensaries.

For reporting, the funds will be managed by the public health facility and it is expected to collate and report on all revenue collected.

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 utilisation. 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 minimise cash payments and loss of funds.

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 progress towards UHC and health security.
— The writer is the founder and director of Pathways Policy Institute