Social Health Authority: Legal hurdles for Gov’t ahead of October roll-out

The Court of Appeal could on Friday make or break all the efforts by the Ministry of Health in the rollout of the new medical insurance scheme.

Three laws - the Social Health Insurance Act, the Primary Healthcare Act, and the Digital Health Act, all of 2023 - were declared unconstitutional by the High Court in early July, on account of, among other things, a lack of public participation.

"We’ve requested the courts to grant us a stay order for the period when the case will be heard and determined. That ruling will be given on the 20th of September,” said Medical Services Principal Secretary Harry Kimtai.

While the ministry remains optimistic that the court's decision will go in its favour, it is also preparing for a different outcome.

"If not, we go back to the 120 days for Parliament to re-enact the laws. We are still within... If we get a negative decision, we have 120 days, and we will react within the period given. We are enacting very valid laws,” PS Kimtai noted.

Should the court not grant stay orders on the High Court decision, the Ministry of Health would be unable to implement the Social Health Authority (SHA) plans.

However, legal matters are not the only headache the ministry has to contend with on the road to the October 1, 2024 roll-out.

The Social Health Authority, as a legal entity, is required to have its own staff. With the now-defunct National Hospital Insurance Fund (NHIF) on its way out, it's unclear when and how the SHA will meet its human resource requirements.

Under the Social Health Insurance Act, which is in contest in court, the Social Health Authority is required to hire its own staff, with NHIF employees needing to apply for jobs in the new entity.

The government, however, has assured NHIF staff that none of them will lose their jobs.

"We submitted the human resource instrument…giving the SHA the number of staff they can employ. We have interim approval to start the process,” noted Kimtai.

The ministry also has to contend with the challenge of the systems that will be used in the rollout of SHA, including the comprehensive integrated health information systems, registration modules, and other critical infrastructure.

Ministry officials have been non-committal about the progress made in these areas.

Beyond preparedness, the ministry is also facing another challenge: the slow uptake of registration into the authority. With just 1.2 million out of a possible 50 million people registered, the ministry has its work cut out.

Counties are also adding to the ministry’s headache by demanding clear protocols for making payments for services provided.

The ministry will be hoping that by the end of this week, the path to the rollout of SHA will become clearer.