Accountability and Health Care Marketization in Kenya: Why Reform Public Law

Abstract

A recent attempt by the Ministry of Health to establish a mandatory social health insurance scheme was vehemently opposed by various inter-est. groups, culminating in the withdrawal of the National Social Health Insurance Fund (NSHIF) Bill.' Their concerns varied. For instance, the Minister of Finance thought that the scheme was unaffordable.? Others doubted whether the government could be entrusted with the management of the proposed fund in light of recent corruption scandals and poor management of the existing National Health Insurance Fund (NHIF).3 It was thus reported that the NHIF lost some KShs. 300 million due to fraudulent claims in 2003 alone.s There were also concerns that because all Kenyans and permanent residents would be compelled by law to contribute to the fund, it not only constituted an abrogation of the freedom of choice= but would also lead to extra taxation of "already overburdened taxpayers."6 Health management organizations were also gravely concerned that they. would lose a large portion of their clients if the NSHIF Bill became law.? The proposed National Social Health Insurance Scheme (NSHIS) should be seen in the context of efforts by successive administrations in Kenya to reform the health care sector. Like other developing countries, Kenya's public health care