Monday, September 27, 2010

NHIF, COTU and FKE

The Industrial Court dismissed the case filed by COTU seeking to stop the implementation of the new NHIF rates.   FKE and COTU have now indicated that they intend to challenge the decision in the High Court.  I just heard the COTU SG threaten a general strike unless government intervenes to stop the rate raises.  Apart from the legal issues raised, I think the case raises important issues on how we intend to build our institutions, a point I alluded to in my last post.   The NHIF is a statutory body incorporated under the NHIF Act.   The Board is established under section 4 and  provides as follows;
 
4. (1) There shall be established a Board to be known as the National Hospital Insurance Fund Board of Management which shall consist of: -
(a) a chairman to be appointed by the President by virtue of his knowledge and experience in matters relating to insurance, financial management, economics, health or business administration;
(b) the Permanent Secretary in the Ministry for the time being responsible for matters relating to health or his representative;
(c) the Permanent Secretary to the Treasury or his representative;
(d) the Permanent Secretary/Director of Personnel Management or his representative; the Director of Medical Services;
(f) one person nominated by the Federation of Kenya Employers;
(g) one person nominated by the Central Organisation of Trade Unions;
(h) one person nominated by the Kenya National Union of Teachers;
(i) one person nominated by the Kenya National Farmers Union;
(j) two members appointed by the Minister as follows -
(i) one person nominated by the Association of Kenya Insurers;
(ii) one person nominated by non-profit making health-care providers;
(k) the chairman of the Kenya Medical Association; and
(l) one member representing non-governmental organisations involved in the provision of health care services, nominated by the Non-Governmental Organizations Council established under the Non-Governmental Organisations Co-ordination Act, 1990.
(2) For purposes of subsection (1) "non-profit making health-care providers" means hospitals managed on a charitable basis by religious organisations.

So where were COTU and FKE when the decision to raise rates was being made?    Is the law suit an excuse for their failure to take part in a process they are legally entitled to participarte? Both COTU (and two other Unions) and FKE are fully represented on the Fund Board and one would expect that before the rate changes were announced, the matters were discussed exhaustively by the Board.   The purpose of having various interest groups represented on the Board is so that specific consideration is given to those special interests.  In other words, the Board has an in built consultative process.   If the COTU or FKE representative fails to present its position on the Board, then COTU and FKE must take responsibility for nominating members to the Board who either do not inform the nominating body of the proposals made for consideration or simply do not participate in the decision making process.  On the hand, given the nature of interests represented, decisions made by the Board  will normally take into account competing interests so that  the end result must may not satisfy all parties.  No party will have an unqualified acceptance of its position.  FKE and COTU should work to  strengthen the institutional capacity of NHIF to make decisions that move the dream of healthcare for all forward.  It is the responsibility of FKE and COTU ensure that NHIF has the capacity to deal with difficult issues within the contraints of existing institutions.  I am afraid that the Courts cannot be a substitute for the hard decisions that need to be made from time to time.


2 comments:

gmeltdown said...

I agree, COTU behavior seems to defeat the very intentions of including them in NHIF board and other parastatal boards. Is it possible COTU raised their issues at the board and they were defeated in the consensus process? In that case they should be democratic enough to embrace the consensus

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