Cofek comments to the National Assembly Health Committee on the Health Laws (Amendment) Bill

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We are pleased to have been invited to make our proposals to your Committee regarding Health Amendment Bill No. 2 of 2021

  1. GENERAL COMMENTS 
  • The proposals being made to amend the Act do not appear clear on what (and how) the proposed amendments would be curing
  • Most of the proposed amendments are made by people with partisan and selfish interest. Public interest has been relegated to the periphery
  • All appointments to the various parastatals need to be made competitive in line with Article 10 and 232 of the Constitution of Kenya. Giving the discretion to either His Excellency the President and or the Cabinet Secretary has the potential to water down the quality of the eventual directors
  • Beyond the human resource element, look at how the Amendments address the effective policy, regulatory and service provision parameters – which assure better governance, accountability, sustained funding and achieving cost-efficiency. In the form they are, emphasis is laid on boards
  • Address the cost and mechanisms of access to high quality medical services – by separating cost of human resource (doctors, nurses etc), equipment, laboratory tests, among others
  • Address inefficiencies and corruption at NHIF. Until then, do not increases members’ contributions
  • Let KEMSA compete with the private sector. Ring-fencing a corrupt and inefficient institution piles costs on the consumer
  • In compliance with the Consumer Protection Act, 2012 Section 94 and generally with the provisions of Article 46 – let Consumers Federation of Kenya (Cofek) remain a nominating agency on the Kenya Nutritionists and Dieticians Institute (KNDI) and all other health sector regulatory bodies
  • Reduce too many Government appointees on boards of health parastatals
  • Professional bodies should not be controlled by Government. They should be regulated. Go for self-regulation instead. Move to have the Executive take over the roles of professional bodies is ultra vires and is fatal especially when compared about the neutrality and objectivity of global professional bodies
  1. SPECIFIC COMMENTS 
  • Cancer board members should include oncologists. The corporate secretary should maintain a cancer registry
  • Kenya Medical Supplies Authority board should be composed of at least 1 medical officer, 1 surgeon, 1 nurse, 1 pharmacist and a consumer representative. KEMSA is serving doctors, not pharmacists. Procurement of medicine must be informed by the doctors. This way, the current wastage will be done away with.
  • On NHIF, Kenya Medical Association and Consumer representative needed. Reduce Government representative. Have Council of Governors on board
  • Pharmacy and Poisons Board – Reduce pharmacists to no more than 2. Get other stakeholders – a doctor, nurse, consumers. Too many pharmacists on PPB occasion a lot of under-cutting and corruption
  • Kenya Medical Practitioners and Dentists Council (KMPDC): This is a key body. It cannot be more than 30 percent composed of doctors. Include a pharmacist, nurse, consumer representative
  • The NHIF should be transformed into a social security fund whose mandate will be to equip, buy drugs and pay for services offered to patients across the country. Some of the roles undertaken by KEMSA should be taken up by the new NHIF
  • Break up NHIF into three (3) entities: (a) ‘Health Bank’; (b) Health Services Board and (c) as NHIF Insurance: (i) As a bank, NHIF will deal with collections and disbursements to accredited health facilities; (ii) As a Health Services Board, NHIF should review strategy based on research and benchmark on evaluating ways and means in which many more Kenyans could access UHC, cheaper medication, re-investments etc; It will also develop standards for accreditation of hospitals and doctors under the special and defined scheme – covering all conditions and as an insurer and (iii) NHIF will offer more options and compete with private sector but allow all special health conditions to be covered – under different terms and subsidized premiums – for the poor
  1. ADDITIONAL COMMENTS 
  • Set up a National Health Standards Regulatory Board – This will be a key institution to assess and rate institutions. Roadside declarations of Level 4 or Level 5 facility without back-up evidence and or a body to monitor compliance to set standards is more urgent than ever before
  • Adjust the National Government Ministry of Health to reflect fact that medical service is a devolved function
  • Provide incentives for private sector investment and Health Financing generally

 

Secretary General, November 15, 2021

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