By Billy Mijungu
Kenya does not need another bureaucratic insurance scheme to manage healthcare. What we need is a simple, transparent, and fair model that makes every citizen a contributor through everyday consumption, not complicated payroll deductions or mandatory registrations.
Let us introduce a 2 percent Health Levy on consumption collected alongside VAT. This small and affordable rate ensures that everyone, whether formally employed, self-employed, or in the informal sector, contributes to healthcare each time they make a purchase. It would spread the cost fairly and sustainably across the entire population.
The proceeds should be ring fenced and distributed equitably by the Commission on Revenue Allocation (CRA) directly to public hospitals and health centres countrywide. CRA would base allocations on population, need, and performance. Governors would then have strong incentives to build and maintain quality medical facilities to attract higher allocations from CRA, thereby creating healthy competition for better service delivery.
Every citizen with an identification card or with a guardian should be able to walk into any registered medical facility, get treatment, and leave without worry. The government can load registration data for compliant hospitals into the national system for verification. In fact, medical records can be available on the eCitizen portal linked to the Social Health Account (SHA), allowing hospitals to verify patients and claim reimbursement instantly. This will simplify access, promote transparency, and eliminate the long queues and corruption associated with insurance cards and manual verification.
To prevent misuse, the Senate must legislate safeguards to ensure that every shilling sent to medical facilities is spent only on patient care, medicines, equipment, and staff, not diverted to seminars, foreign trips, or non-medical administrative expenses. Funds for policy and administrative activities can remain under county or national ministries, but not touch hospital budgets.
KEMSA must also evolve. Its current role of warehousing and redistributing medical supplies adds unnecessary costs. Suppliers should deliver directly to hospitals while KEMSA focuses on coordination, oversight, and quality assurance, ensuring that facilities receive genuine, affordable, and timely supplies.
We do not need NHIF or SHIF to make universal health access work. We only need integrity, smart fiscal design, and clear legislation that puts hospitals, not bureaucrats, at the centre of healthcare funding.
