Report Of The Health Commiittee On Health Amendment Bill

REPUBLICOFKENYA

THIRTEENTHPARLIAMENT

THESENATE

STANDINGCOMMITTEEONHEALTH

REPORTONTHECOMMITTEEONHEALTHONITSCONSIDERATIONOF THE HEALTH (AMENDMENT)BILL,2025(SENATEBILLSNO.12 OF2025)

.AID

DATE

20

TABLED BY

COMMITTEE

Clerks Chambers, Parliament Buildings, NAIROBI.

CLERK AT THE TABLE

December,2025

Contents

| LISTOFABBREVIATIONS | LISTOFABBREVIATIONS | |---------------------------------------|--------------------------------------------| | PRELIMINARIES | PRELIMINARIES | | ESTABLISHMENTANDMANDATEOFTHECOMMITTEE | ESTABLISHMENTANDMANDATEOFTHECOMMITTEE | | CHAIRPERSON'SFOREWORD | CHAIRPERSON'SFOREWORD | | CHAPTERONE | CHAPTERONE | | 1. | INTRODUCTION 6 | | 1.1. | OBJECTIVESOFTHEBILL 6 | | 1.2. | OVERVIEWOFTHEBILL | | CHAPTER TWo 8 | CHAPTER TWo 8 | | 2. | OVERVIEWOFPUBLICPARTICIPATION | | CHAPTER3 11 | CHAPTER3 11 | | 3. | COMMITTEEOBSERVATIONSANDRECOMMENDATIONS 11 | | 3.1. | COMMITTEEOBSERVATIONS. 11 | | 3.2. | COMMITTEERECOMMENDATIONS 13 |

LIST OFABBREVIATIONS

COG

Council of County Governors

CS

Cabinet Secretary

ICCPR

International Covenant on Civil and Political Rights

KELIN

Kenya Legal and Ethical Issues Network

KLR

The Kenya Law Reports

MoH

Ministry of Health

NGEC

National Gender and Equality Commission

SHIF

TheSocial Health InsuranceFund

UHC

Universal Health Coverage

WHO

World Health Organization

PRELIMINARIES

Establishment and Mandate of the Committee

The Standing Committee on Health is established pursuant to standing order 228 (3) and theFourthScheduleof theSenateStandingOrders and ismandatedtoconsider allmattersrelatingtomedicalservices,publichealthandsanitation.

Pursuant to Standing Order 228(4), the Committee is specifically mandated to-

• b) study the programme and policy objectives of the Ministry of Health and its departments, and the effectiveness ofthe implementation thereof;

2. a)investigate,inquire into,and report on all matters relating to the mandate, management,activities,administrationandoperationsoftheMinistryof Health andits departments; 3. C studyandreviewall legislationreferredtoit;

• e) considertheBudgetPolicyStatementinlinewiththeCommittee'smandate;
• d) study, assess and analyze the success of the Ministry of Health and departmentsassignedtoit asmeasuredbytheresultsobtained ascompared with theirstated objectives;

6. reportonallappointmentswheretheConstitution or anylawrequires the Senate to approve; 7. h)considerreportsofCommissionsandIndependentOfficessubmittedtothe Senatepursuant totheprovisions ofArticle254oftheConstitution; 8. makereportsand recommendations totheSenateasoftenaspossible, g includingrecommendationsforproposed legislation; 9. examineanystatementsraised bySenators onamatterwithinitsmandate;and 10. D followupandreportonthestatusofimplementationofresolutionwithinits mandate;and 11. k)follow up and report on the status of commitments made by theCabinet Secretariesin theirresponse toquestionsunderStandingOrder51C.

Committee Membership

The Committee is comprised of the following members-

1. Sen. Jackson K. Mandago, EGH, MP

Chairperson

• 2.Sen. Mariam Sheikh Omar, MP

Vice-Chairperson

3. Sen. Justice (Rtd.) Stewart Madzayo, EGH, MP -

Member

• 4.Sen.Ledama Olekina, MP

Member

5. Sen. David Wakoli,MP

Member

• 6.Sen.Richard Onyonka,MP

Member

• 7.Sen. Tabitha Mutinda,MP

Member

• 8.Sen. Hamida Kibwana,MP

• Member

9. Sen. Joseph Githuku,MP

• Member

CHAIRPERSON'SFOREWORD

The Health (Amendment) Bill, 2025 (Senate Bills No. 12 of 2025) was introduced in the Senate by way of First Reading on Tuesday 23rd September, 2025 and thereafter stoodcommitted to theCommitteeonHealthfor consideration.

The principal object of the Bill is to prohibit the detention of patients or the bodies of deceased patients by health facilities as a means of securing payment for outstanding medical or mortuary bills. The Bill, further, seeks to make it a criminal offence for any person responsible for discharging patients in a health facility to detain them due to unpaid medical bills. This Bill reinforces Kenya's commitment to upholding the right to human dignity and protection from arbitrary detention as enshrined in the Constitution.

In accordance with the provisions of Article 118 of the Constitution and standing order 145 (5) of the Senate Standing Orders, the Committee subsequently, through public advertisements that appeared in the Daily Nation and the Standard Newspapers that appeared on Wednesday, 30"h September, 2025, invited interested members of the public to submit any representations that they may have on the Bill by way of written memoranda.

The Committeereceivedwrittenmemorandafrom theMinistry of Health,the Council of Governors, the National Gender and Equality Commission (NGEC), the Kenya Ethical and Legal Issues Network and Aga Khan Health Services. At the close of public participation period, the Committee prepared a comprehensive matrix of all submissions, views and proposed amendments for its consideration.

Upon deliberation, the Committee observed that the practice of detaining patients or international human rights standards, as reaffirmed by the World Health Organization (WHO)in its 2020 paper titled Ending Hospital Detention for Nonpayment of Bills: Legal and HealthFinancing Options.

TheCommitteereaffirmed that theobjectiveof theBill isnot tocriminalize the recovery of lawful debts but to outlaw the unethical and unlawful act of detaining patients or corpses for non-payment of medical fees, a practice already condemned by Kenyan courts in the case of Emma Muthoni NjerivNairobiWomen's Hospital KEHC 8797 (KLR) decision.

The Committee further acknowledges that Kenya has made significant progress towards achieving Universal Health Coverage through the establishment of the Social Health Insurance Fund, Emergency, Chronic and Critical Illness Fund, and the PrimaryHealthcare Fund.These mechanisms are designed to reduce the financial burden on citizens when seeking medical services and consequently eradicate unethical practices such as hospital detention for non-payment of medical fees.

As I conclude, I wish to sincerely thank the Office of the Speaker and the Office of the Clerk of the Senate for the support extended to the Committee in execution of its mandate. I also wish to extend my gratitude to the Committee members for their diligence, commitment and insightful contributions throughout consideration of this Bill.

It is now my pleasant duty, pursuant to standing order 148 (1) of the Senate Standing Orders, to present the Report of the Standing Committee on Health on its consideration of the Health (Amendment) Bill, 2025 (Senate Bills No. 12 of 2025).

Date...

Sign&d....

SEN.JACKSONK.ARAP MANDAGO,EGH, MP, CHAIRPERSON,STANDINGCOMMITTEEONHEALTH.

1.Introduction

• 1 The Health (Amendment) Bill, 2025 (Senate Bills No. 12 of 2025) was published in the Kenya Gazette Supplement No. 120 on July 18th, 2025. The Bill seeks to prohibit the detention of patients and corpses in hospitals owing to the inability of a patient tomeetthehospitalfees.
• 2 The Bill was introduced in the Senate by way of First Reading on Tuesday, 23rd September2025and thereafterstoodcommittedtotheCommitteeonHealthfor consideration.A copyof theBill aspublished and introduced to theSenatehas been attached to thisreport asAnnex 2.
• 3)In compliance with the provisions of Article 118 of the Constitution and Standing Order 145(5)of the Senate Standing Orders,the Committee proceeded to undertake public participation on the Bill. In this regard, the Committee published October, 2025, inviting members of the public to submit written memoranda to the Committee on the Bill. A copy of the advertisement as published has been attached to thisreport asAnnex3.

1.1.Objectives of the Bill.

• 4)TheobjectsoftheBill areto-
• (a)The Bill seeks to amend the Health Act to prohibit health facilities from detaining patients or their corpses over unpaid medical bills. This aims to protect the patients' constitutional rights to dignity, freedom of movement, and liberty as guaranteed under Articles 28, 29, and 39 of the Constitution.
• b) discharge of patients in Hospital to detain a patient or cause the detainment of a patient or a corpse of a patient.

1.2.Overview of the Bill

• 5)The Bill seeks to insert a new section 7A to the Health Act to-
• (a) prohibit the detention of patients or corpses of patients by health facilities as a securityforpayment of medical fees;
• (b) Make it a criminal offence for any person in charge of a health facility to lien for outstanding medical fees, making them personally liable for such actions; and

CHAPTERONE

• C Empower the Cabinet Secretary for Health with the responsibility to develop regulations aimed at establishing lawful procedures and mechanisms for health facilities to recover unpaid fees for services rendered,providing an alternative to detention.

CHAPTERTWO

2.Overview of Public Participation

• 6)The Committee received a total of five (5) written memoranda from five stakeholders comprising the Ministry of Health (MoH), The Council of County Governors(CoG),TheNational Gender and Equality Commission,theAgaKhan HealthCareservices andthe KenyaLegalandEthical Networks other government agencies as well as the private sector.A comprehensive matrix of all submissions, views and proposed amendments has been attached as Annex 4 on this report.
• 7) The Ministry of Health advanced several arguments against the proposed amendmentasfollows-
• a) Mortuary services are categorized as billable services and are therefore subject to applicable fees and charges as per the institutions'approved rates.In their view, charging for such services cannot be criminalized as proposed in the Bill.
• b) Mortuary and patient services are already provided for under the tariffs for healthcare under the Social Health Insurance scheme,which is designed to alleviate any financial burdens that may be experienced by patients and their families.
• c) The issue of non-payment of fees should be handled administratively rather than through criminalization of healthcare providers.
• 8)The Aga Khan Health Services submitted as follows -
• (a) while the Bill protects patient rights under Articles 28, 29, and 39 of the Constitution (dignity, security, and freedom of movement), it fails to protect health facilities' property rights under Article 40, specifically the right to collectfeesfor services rendered.
• (b)The stakeholder contended that patient rights are provided for in the primary legislation while health facility rights are relegated to subsidiary regulations, creating a hierarchy of laws that devalues provider interests.
• (c)Private facilities operate without government subsidies, relying entirely on patient payments. The stakeholder argued that unpaid bills directly threaten operational capacity including inability to pay staff salaries, equipment maintenance challenges, medicine stock depletion, compromised emergency readiness and risk offacility closures due to revenue losses.
• (d)healthfacilitiesenterintocontractual agreementswithpatientsforprovision ofhealth services,however,patients andfamiliesincreasinglyrefusepayment anddecline transfers to affordablefacilities.The situation isparticularly acute with foreign patients who obtain court orders for discharge or release and then leave the country, abandoning legal proceedings.

• (e)Court petitions are used tactically with media publicity to pressure facilities, "paper judgments" and even successful court cases rarely award costs to facilities, leaving them with additional legal expenses.
• (f) The amendment creates a passive incentive for intentional non-payment since facilities lose all leverage. It also undermines existing contractual relationships and freedom of contract.
• (g) Under the Kenya National Patients, Rights Charter 2023, patients have the to choose facilities they can afford. Further, under the Kenya Health Sector Referral Implementation Guidelines 2014, lack of financial resources is a legitimate ground for patient referral, and patients or next of kin must consent to transfers or sign forms indicating they act against medical advice. Most patients, however, refuse to be transferred to other hospitals.
• (h) As a result of the above arguments, the stakeholder requested the Senate Committee on Health to -
• (i Exemption private health facilities from the application of Section 7A given their unique funding model
• (ii) Include a new subsection requiring patients to ensure fees are fully paid or provide an acceptable enforceable undertaking to the health facility,if the Committee retains the clause.
• (i) Delete the clause empowering the Cabinet Secretary to make regulations for recovery of fees as it goes against freedom.of contract
• (iv)( or honor their payment undertakings.
• 9) The Council of County Governors (COG) made the following submissions --
• (a) The provision allowing the Cabinet Secretary for Health to make regulations on fee recovery would lead to micromanagement of counties, yet health is a devolved function under the Constitution. This would undermine the constitutionalframeworkofdevolution.
• (b)The stakeholder however indicated that the rest of the provisions in the Bill are okay.
• 10) The National Gender and Equality Commission proposed -
• (a) Deletion of the words "a health facility"" with ""both private and public facilities" to make it explicitly clear that the provision will apply to both public and private health facilities. This removes any ambiguity about the Bill'sscope.

• (b) Provision of a clear penalty for facility officers who detain patients for the purpose of enforcing medical bills. NGEC proposed a fine not exceeding two million shillings.
• (c) Inclusion of a provision that ""the facility and the kin of a discharged patient and/or of the deceased shall agree on the modalities of payment of both parties' interests.
• 11) The Kenya Legal and Ethical Issues Network (KELIN) submitted as follows-
• (a) There is need for a clear definition of the term "detention" to ensure that all circumstances foreseen are captured in the Bill.
• (b) The Bill should prescribe a specific penalty for violations of the prohibition against detention. Without a clear penalty, enforcement may be inconsistent.
• (c) There is need for clarity as to whether the criminalization applies only to detentions arising out of emergency care or in all instances, since the amended section dealswith emergencycare.
• (d) Suggest a redress mechanism for kins for detained patients

CHAPTER3

3.COMMITTEEOBSERVATIONSANDRECOMMENDATIONS

3.1.Committee Observations

• 12) Having considered the Health Amendment Bill (Senate Bills No.12 of 2025), and submissionsfrom stakeholders,the Committeemadethefollowing observations-
• 1) The World Health Organization in its paper Titled "Ending Hospital Detention forNonpaymentofBills:Legal andHealthFinancingOptions" published in the year 2020,advices members that no person should be detained in a hospital against their will for non-payment of bills and user fees. Norshould theremainsofa deceasedpatientbewithheld andnotreleasedfor unpaidhospitalbillsanduserfees.WHOreiterates that thepractice of hospital detention for non-payment of bills is contrary to international human rights laws and to Universal Health Coverage (UHC) objectives.
• 2) WHO has further advised that the legal options available to end the practice of hospital detention for non-payment of bills and user fees, includes prohibition of the practice of hospital detention; recognizing international human rights in national legislation; committing to Universal Healthcare Coverage in domesticlaws;ensuring gproper implementation and enforcement mechanisms; and establishing information and reporting mechanisms.

4. 3)Kenyahasratified anddomesticatedanumberofInternationalHumanRights instruments including theInternational CovenantonCivil and Political Rights,International Covenanton Socio-economic and Cultural Rights and the Universal Declaration on Human Rights. Article 1l of the ICCPR for exampleprovidesthatnooneshallbeimprisonedmerelyon thegroundof inability to fulfil a contractual obligation. This provision prohibits the deprivation of personal liberty for failure to pay a debt. It is for this reason that the act of detaining a patient as a lien for payment of medical fees is not only immoral but also illegal and violates the International Human Rights instruments which are the foundation of the Bill of Rights under Chapter 4 of theKenyan Constitution.

• 4) The High Court of Kenya has also pronounced itself on the issue of hospital detentionsinthecaseof EmmaMuthoni Njeri vNairobi Women's Hospital[2021]KEHC 8797(KLR)wherethecourt stated asfollows in under the law to hold any person within the hospital for failure to pay medical bills.The Respondent's action of holding the Petitioner over an unpaid medical bill makes it culpable for illegally detaining the Petitioner. Although the Petitioner was in breach of her contractual obligation to pay her bill, the Respondent had other options open to it to recoverthe debtandshouldnothave detained thePetitioner."

• 5) The Bill seeks to end detention of patients or corpses of patients as lien for outstanding medical fees or mortuary fees and make it a criminal offence for the Cabinet Secretary for health to develop regulations to guide health facilities in alternative methods of recovery of medical or mortuary fees.
• 6) The Bill aligns with Kenya's constitutional rights to human dignity provided under Article 28,freedom of movement anchored under Article 39,and protection from arbitrary detention protected under Article 29 of the Constitution which are all threatened by the act of hospital detention. Hospital detention constitutes cruel,·inhuman,and degrading treatment, violating patients' right to dignity. Hospital detainees face abusive conditions, psychological trauma, and increased health risks from overcrowded facilities including women, children, and the poor, making it inherently discriminatory.
• 7) The Committee notes the concerns raised by the Ministry of Health who seek a deletion of.theprovision intheBill citingreasons thatMortuary services are classified as billable services under approved institutional rates and are covered within Social Health Insurance tariffs designed to alleviate financial burdens on families. Charging for these services constitutes legitimate administrativepracticethat shouldnotbecriminalized.Issuesrelatedtononpayment of fees should be resolved through administrative mechanisms rather than through criminal sanctions against healthcare officers.The committee however resolved that what isbeing criminalizedin theBill is not the act of charging medical and mortuary fees but rather the act of detention of a patient or corpse for inability to pay the medical fees, an act which is condemned internationally by WHO and settled by the Kenyan courts in the case of Emma Muthoni Njeri Nairobi Women'sHospital [2021] KEHC 8797 (KLR).
• 8) The Committee further notes that Kenya has made big strides in the attainment of Universal Healthcare Objectives as proposed by WHO through the establishment of the Social Health Insurance Fund, Emergency, Chronic and Critical illnesses Fund, The Primary Healthcare Fund and the Facility ImprovementFund.Thesefundswere anchoredin theKenyanlawto alleviate the financial burden suffered when accessing medical care in Kenya. It is therefore a stepforward towards eradicating hospital detention of patients for inability to pay medical fees as proposed by WHO.

5. s s s ( Services, who criticized the Bill for protecting patients' rights at the expense of the property rights of the health facilities as provided for under Article 40 of the Constitution. They indicated that the Bill threatens the existence of

private health facilities who don't rely on government subsidies and also affect operations such as payment of salaries, equipping the hospital with medicines and attending to emergency care among others. The Committee however resolved that it is the right of health facilities to charge for services rendered topatientssavethatdetentionofpatientscannotbeutilized as a method of recovery of the fees. The health facilities can use alternative means such as payment plans, accepting promissory notes accompanied by securities, exploring recovery through alternative dispute resolution or throughcourts.

• 10) Concerning the offence created in Bill, the committee resolved that the general penalty of a fine not exceeding two million shillings or to imprisonmentfor atermof threemonthsasprovidedfor undersection111 of the Health Act is sufficient to deter acts of detention of patients in health facilities by persons in charge of the discharge of the patients.

3.2.CommitteeRecommendations

• 13) The Committee therefore recommends that the Senate passes the Bill without amendments.

Annex 1:

Minutes of the Committee Sittings

MEMBERSPRESENT

13TH PARLIAMENT 14TH SESSION

MINUTES OF THE SEVENTY- FIRST (71ST)VIRTUAL- SITTING OF THE STANDINGCOMMITTEE NOVEMBER,2025AT11.00AMINCOMMITTEEROOM6,BUNGETOWER ON HEALTHHELD ON\_TUESDAY, 25TH

1. Sen. Jackson K. Arap Mandago, EGH, MP

• 2.Sen. Mariam Sheikh Omar, MP

• Chairperson

• Vice-Chairperson

3. Sen. Richard Onyonka, MP

• 4.Sen. Tabitha Mutinda, MP

• -Member

5. Sen. Hamida Kibwana, MP

• -Member

ABSENT WITH APOLOGY

1. Sen. Justice (Rtd) Stewart Madzayo, EGH, MP 3. Sen. David Wakoli, MP 3. 2.Sen.Ledama Olekina, MP 4. 4.Sen. Joseph Githuku Kamau, MP

SENATESECRETARIAT

• -Member

• Member

• Member
• Member
• -Member

1. Mr. Humphrey Ringera

• -Senior Research Officer

2. Mr. David Ngamate

• Clerk Assistant

3. Mr. Gilbert Juma

• Legal Counsel

4. Ms. Lilian Onyari

• Fiscal Analyst

5. Mr. David Munene

• Research Officer

6. Mr. Ian Otieno

• Audio Assistant

• 7.Mr. Jack Lemeteki

• -Media Relations Officer

8. Ms. Ivy Marubu

• Intern

PRELIMINARIES

MIN/SEN/SCH/361/2025

The meeting was called to order at twenty-five minutes past eleven o'clock and the proceedings commenced with a word of prayer and brief introductions of those present.

MIN/SEN/SCH/362/2025

ADOPTIONOFTHEAGENDA

The agenda of the meeting was adopted after being proposed by Sen. Hamida Kibwana, MP and seconded by Sen. Mariam Sheikh Omar, MP, as listed below-

• 1.Preliminaries;

2. Adoption of the Agenda;

• 3.Confirmation of Minutes of the previous Committee meetings
• a. Minutes of the 60th Sitting of the Committee held on 6lh November, 2025;
• b. Minutes of the 65th Sitting of the Committee held on 13th November, 2025;
• c. Minutes of the 70"h Sitting of the Committee held on 18th November, 2025;

d. Minutes of the 51st and 52nd Sitting ofthe Committee held on 22nd Oct, 2025;

• e. Minutes of the 53rd and 54h Sitting ofthe Committee held on 23rd Oct, 2025;

2. f.Minutes ofthe 55th and 56"h Sitting ofthe Committee held on 24"h Oct, 2025 4. Matters Arising from the Minutes of the previous meetings; 5. Consideration of the Health (Amendments) Bill (Senate Bills No. 12 of 2025) (CommitteePaper No.154); 6. Consideration of the Committee Report on the County Oversight Visits Kitui, Makueni and Machakos Counties (Committee Paper No.155); 7. Any other Business; and 7. 8.Adjournment/Date of the Next Meeting

MIN/SEN/SCH/363/2025

CONFIRMATIONOFMINUTESOFTHEPREVIOUS COMMITTEEMEETINGS

• a)The Minutes of the 60th meeting held on Thursday 6th November, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. Richard Onyonka, MP and seconded by Sen. Tabitha Mutinda, MP;
• b) The Minutes ofthe 70"h meeting held on Tuesday 18th November, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. Tabitha Mutinda, MP, and seconded by Sen. Mariam Sheikh Omar, MP;
• c)The Minutes of the 65"h meeting held on Thursday 13th November, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. Mariam Sheikh Omar, MP, and seconded by Sen. Richard Onyonka, MP;
• d) The Minutes ofthe 51s meeting held on Wednesday 22nd October, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. Tabitha Mutinda, MP, and seconded by Sen. Richard Onyonka, MP;
• e) The Minutes of the 52"d meeting held on Saturday 22nd October, 2025 at 12.00 were confirmed as a true record of the proceedings having been proposed by Sen. Richard Onyonka, MP, and seconded by Sen. Tabitha Mutinda, MP;
• f)The Minutes of the 53rd meeting held on Thursday 23rd October, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. Richard Onyonka, MP, and seconded by Sen. Tabitha Mutinda, MP;
• g) The Minutes of the 54th meeting held on Thursday 23rd October, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. Tabitha Mutinda, MP, and seconded by Sen. Richard Onyonka, MP;
• h) The Minutes of the 55th meeting held on Friday 24th October, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. Tabitha Mutinda, MP, and seconded by Sen. Richard Onyonka, MP; and
• i)The Minutes of the 56th meeting held on Friday 24th October, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. Tabitha Mutinda, MP, and seconded by Sen. Richard Onyonka, MP.

MIN/SEN/SCH/364/2025 MATTERSARISING

a)UnderExMIN/SEN/SCH/335/2025-AnyOtherBusiness

The Committee resolved to undertake the Foreign Travel to the United Arab Emirates during the December Recess and the Chairperson requested the delegation that has been nominated to attend to liaise with the Secretariat for logistical planning. Consequently, the Committee resolved to undertake the said visit tentatively from 18th to 26" January, 2026

MIN/SEN/SCH/365/2025

| CONSIDERATION OF THE | |-----------------------------------------------| | HEALTH (AMENDMENTS) BILL (SENATE BILLS NO. 12 | | OF 2025) (COMMITTEE PAPER NO. 154); |

1. The Secretariat presented for consideration the Health (Amendments) Bill (Senate Bills No. 12 of 2025 as contained in the Committee Paper No. 154.

Committee Resolution

• 2.After deliberations, the Committee therefore recommended that the Senate passes the Bill without amendments.

3. The Committee Report was unanimously adopted after being proposed by Sen. Richard Onyonka, MP and'seconded by Sen. Tabitha Mutinda, MP

MIN/SEN/SCH/366/2025 ANY OTHER BUSINESS

The Committee resolved that the Committee Report on the County Oversight and Networking Engagements to Kitui, Makueni and Machakos be circulated on WhatsApp ahead of the meeting for their perusal and advance reading.

MIN/SEN/SCH/367/2025 ADJOURNMENT

There being no other business, the meeting ended at ten minutes past one o'clock. The next meeting shall be held on notice.

Dalc...

Signdd...

SEN.JACKSONK.AEAPMANDAGO,EGH,MP, CHAIRPERSON,STANDINGCOMMITTEE ONHEALTH.

13THPARLIAMENTI4THSESSION

MINUTES OF THE SEVENTIETH (7OTH)SITTING OF THE STANDING COMMITTEE ON HEALTH HELD ON TUESDAY,18TH NOVEMBER, 2025 AT 11.00AMINCOMMITTEEROOM6,BUNGETOWER

MEMBERSPRESENT

• 1.Sen.Jackson K.Arap Mandago,EGH, MP

3. Sen. Justice (Rtd) Stewart Madzayo, EGH, MP

• 2.S Sen. Mariam Sheikh Omar, MP
• 4.Sen.Tabitha Mutinda, MP

5. Sen. Hamida Kibwana, MP

ABSENTWITHAPOLOGY

1. Sen. Ledama Olekina, MP 3. Sen. Richard Onyonka, MP 2. Sen. David Wakoli, MP 4. Sen. Joseph Githuku Kamau, MP

SENATESECRETARIAT

| 1. Mr. Humphrey Ringera | - Senior Research Officer | |---------------------------|-----------------------------| | 2. Mr. David Ngamate | - Clerk Assistant | | 3. Mr. Gilbert Juma | - Legal Counsel | | 4. Ms. Lilian Onyari | - Fiscal Analyst | | 5.Mr. David Munene | - Research Officer | | 6.Mr. Ian Otieno | - Audio Assistant | | 7.Mr.Jack Lemeteki | -Media Relations Officer | | 8. Ms. Ivy Marubu | - Intern |

MIN/SEN/SCH/354/2025

PRELIMINARIES

The meeting was called to order at twenty-two minutes past eleven o'clock and the proceedings commenced with a word of prayer and brief introductions of those present.

• Chairperson
• -Member
• Vice-Chairperson
• -Member
• Member
• Member
• -Member
• -Member
• Member

MIN/SEN/SCH/355/2025

ADOPTIONOFTHEAGENDA

The agenda of the meeting was adopted after being proposed by Sen. Mariam Sheikh Omar, MP, and seconded by Sen. Tabitha Mutinda, MP, as listed below-

• 1.Preliminaries;
• a) Prayer
• b)Introductions

2. Adoption of the Agenda; 3. Confirmation of Minutes of the previous Committee meetings

• a Minutes of the57th Sitting of the Committee held on28th October, 2025;
• b) Minutes of the 58th Sitting of the Committee held on 30th October, 2025;
• Minutes of the 60h Sitting of the Committee held on 6"h November, 2025; and
• d Minutes of the 65th Sitting of the Committee held on 13th November, 2025

4. Matters Arising from the Minutes of the previous meetings; 5. Consideration of the Health (Amendments) Bill (Senate Bills No. 12 of 2025)

• (Committee Paper No. 152);

6. Any other Business; and

• 7.Adjournment/Date of the Next Meeting

CONFIRMATIONOFMINUTESOFTHEPREVIOUS MIN/SEN/SCH/356/2025

MEETING

• a) The Minutes of the 57th meeting held on Tuesday, 28th October, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. Mariam Sheikh Omar, MP, and seconded by Sen. Tabitha Mutinda, MP; and
• b) The Minutes of the 58th meeting held on Thursday, 30th October 7, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. Tabitha Mutinda, MP, and seconded by Sen. Mariam Sheikh Omar, MP.

MATTERSARISINGFROMTHEMINUTESOF MIN/SEN/SCH/357/2025

THEPREVIOUSMEETING

There were no matters arising from Minutes of the previous Committee meetings

CONSIDERATION OF THE HEALTH (AMENDMENTS) BILL (SENATE BILLS NO. 12 OF 2025) (C0MMITTEE PAPER N0. 152);

MIN/SEN/SCH/358/2025

1. The Secretariat presented for consideration the Health (Amendments) Bill (Senate Bills No. 12 of 2025) as contained in Committee considered the Committee Paper No. 152

CommitteeObservations

• 2.Duringits consideration theCommitteeobserved that-
• a) The World Health Organization in its paper Titled "Ending Hospital Detention for Nonpayment of Bills: Legal and Health Financing Options" published in the year 2020, advices members that no person should be detained in a hospital against their will for non-payment of bills and user fees. Nor should the remains of a deceased patient be withheld and not released for unpaid hospital bills and user fees;
• b) WHO has further advised that the legal options available to end the practice of hospital detention for non-payment of bills and user fees, includes prohibition of the practice of hospital detention; recognizing international human rights in national legislation; committing to Universal Healthcare Coverage in domestic laws; ensuring proper implementation and enforcement mechanisms; and establishing information and reporting mechanisms;
• C Kenya has ratified and domesticated a number of International Human Rights instruments including the International Covenant on Civil and Political Rights, International CovenantonSocio-economic and Cultural Rights and theUniversal Declaration on Human Rights. Article 11 of the ICCPR for example provides that no one shall be imprisoned merely on the ground of inability to fulfil a contractual obligation. This provision prohibits the deprivation of personal liberty for failure to pay a debt. It is for this reason that the act of detaining a patient as a lien for payment of medical fees is not only immoral but also illegal and violates the International Human Rights instruments which are the foundation of the Bill of Rights under Chapter 4 of the Kenyan Constitution.

3. The Committee further observed that The High Court of Kenya has also pronounced itselfon theissueofhospital detentions

• 4.The Committee observed that theBill aligns withKenya's constitutional rights tohuman dignity provided under Article 28, freedom of movement anchored under Article 39, and protectionfromarbitrarydetentionprotected under Article29 of the Constitution which are all threatened by the actof hospital detention.Hospital detentionconstitutescruel, inhuman, and degrading treatment, violating patients' right to dignity.
• 5.Followingits consideration,the Committee recommended that theSenatepasses theBill without amendments.

MIN/SEN/SCH/359/2025 ANYOTHERBUSINESS

1. The Committee resolved that necessary arrangements be made during oversight visits to provide an update of the different legislative business such as Bills, Motions and Petitionsbeing considered toraise awareness onitsfunctions and mandate;and

2. The Committee to be updated frequently on different statutory instruments tabled in Parliament (both Houses) touching on its mandate

MIN/SEN/SCH/360/2025 ADJOURNMENT

There being no other business, the meeting ended at twenty-four minutes past twelve o'clock. The next meeting shall be held on notice.

Signbd...

Datc.....

SEN.JACKSONK.ABAPMANDAGO,EGH,MP, CHAIRPERSON,STANDING COMMITTEE ONHEALTH.

13TH PARLIAMENT J4TH SESSION

• Member
• -Member
• Member
• -Member
• -Member
• -Senior Research Officer
• Legal Counsel
• -Clerk Assistant
• Fiscal Analyst
• -Audio Assistant
• -Research Officer
• -Attache

PRELIMINARIES

MINUTESOFTHESIXTY-FIFTH(65TH)HYBRIDSITTINGOFTHESTANDING COMMITTEE ONHEALTHHELDONTHURSDAY,13THNOVEMBER,2025AT 11.00AM IN COMMITTEE ROOM 6,BUNGE TOWER ANDON ZOOM MEETINGPLATFORM

MEMBERSPRESENT

1. Sen. Jackson K. Arap Mandago, EGH, MP

• Chairperson

• 2.Sen.Mariam Sheikh Omar,MP

• Vice-Chairperson

3. Sen. Richard Onyonka, MP

• -Member

4. Sen. Joseph Githuku Kamau, MP

• -Member

• 5.Sen. Hamida Kibwana, MP

ABSENTWITHAPOLOGY

• 2.Sen. Ledama Olekina, MP
• 1.Sen.Justice (Rtd) Stewart Madzayo, EGH, MP

3. Sen. David Wakoli, MP

• 4.Sen.Tabitha Mutinda, MP

SENATESECRETARIAT

2. Mr. David Ngamate 1. Mr. Humphrey Riingera 3. 3.Mr. Gilbert Juma 5. Mr. David Munene 4. Ms. Lilian Onyari 6. Mr. Ian Otieno 7. Ms. Ilhan Ahmed

MIN/SEN/SCH/337/2025

The meeting was called to order at twenty-four minutes past eleven o'clock and the proceedings commenced with a word of prayer and brief introductions of those present.

MIN/SEN/SCH/338/2025

ADOPTION OF THE AGENDA

The agenda of the meeting was adopted with amendments after being proposed by Sen. Mariam Sheikh Omar, MP, and seconded by Sen. Hamida Kibwana, MP, as listed below-

• 1.Preliminaries;
• a) Prayer
• b)Introductions
• 2.Adoption of the Agenda;
• 3.Confirmation of Minutes of the previous Committee meetings;
• a) Minutesofthe49thSittingoftheCommitteeheldon25hSeptember2025;and
• b) Minutes of the61s Sittingof the Committeeheld on 11th November 2025

4. Matters Arising from the Minutes of the previous meetings;

• Consideration of the Health (Amendments) Bill (Senate Bills No. 12 of 2025)

5. (Committee paper No. 152); 6. Any other Business; and

• 7.Adjournment/Date of the Next Meeting

MIN/SEN/SCH/339/2025

CONFIRMATIONOFMINUTESOFTHE

PREVIOUS MEETING

• The Minutes of the 49"h meeting held on Thursday 25th September, 2025 at 11.00am were confirmed as a true record of the proceedings having been proposed by Sen. Mariam Sheikh Omar, MP, and seconded by Sen. Richard Onyonka, MP; and
• b) The Minutes of the 63rd meeting held on Tuesday 11th November 7, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. Hamida Kibwana, MP, and seconded by Sen. Joseph Githuku Kamau, MP;
• c) The Minutes of the 64h meeting held on Tuesday 11th November 7, 2025 were confirmed as a true record of the proceedings having been proposed by Sen. Hamida Kibwana, MP, and seconded by Sen. Joseph Githuku Kamau, MP.

1. The Committee was informed that following the introduction of the Health (Amendments) Bill (Senate Bills No.12 of 2025), the Committee had facilitated public participation through public advertisements that appeared in both the Daily Nation and the Standard Newspapers on Wednesday, 30th September, 2025;

| MIN/SEN/SCH/340/2025 | MATTERSARISINGFROMTHEMINUTESOF THEPREVIOUSMEETING | |----------------------------------------------------|-------------------------------------------------------------------------------------------------------| | Therewere no matters arising. MIN/SEN/SCH/341/2025 | OF THE HEALTH CONSIDERATION (AMENDMENTS) BILL (SENATE BILLS NO.12 OF 2025) (C0MMITTEE PAPER N0. 153): |

• 2.The Committee was further informed that invitations had been invited from the Ministry of Health, the Council of Governors, the Rural & Urban Private Hospitals Association (RUPHA), the Kenya Medical Practitioners and Dentists Union (KMPDU); and the Christian Health Association of Kenya;

3. The Committee was further informed that the public participation period had since lapsed and theSecretariat had processed the public representations by collating them in a matrixfor Committee consideration. 4. The Committee resolved to consider the matrix in its next Sitting when majority of the Members would be available physically.

MIN/SEN/SCH/342/2025 ANYOTHERBUSINESS

1. The Committee was informed that oversight visit to Bungoma and Kakamega counties had been approved and the secretariat had consequently communicated to the two counties to provide necessary support during the visit. Members were further urged to confirm their attendance for logistical arrangements; and 2. The Committee was informed that the Speaker of the Senate had declined a request by the Committee to undertake a foreign travel from 17th to 22nd November, 2025 on account that the House would be in Session. Consequently, Members were requested to propose a new date preferably during the December recess.

MIN/SEN/SCH/343/2025 ADJOURNMENT

There being no other business, the meeting ended at fifty-two minutes past eleven o'clock. The next meeting shall be held on notice.

Signdd......

......Datc...

SEN.JACKSONK.ABAPMANDAGO,EGH,MP, CHAIRPERSON.STANDING COMMITTEEONHEALTH.

Annex 2:

Copy of the the Health (Amendment) Bill, 2025 (Senate Bills No. 12 of 2025)

SPECIALISSUE

KenyaGazetteSupplementNo.120(SenateBillsNo.12)

REPUBLICOFKENYA

KENYAGAZETTESUPPLEMENT

SENATE BILLS,2025

NAIROBI, 18th July, 2025

CONTENT

BillforIntroductionintotheSenate

PAGE

TheHealth(Amendment)Bill,2025

175

THE HEALTH (AMENDMENT) BILL,2025 ABill for

• ANACTofParliamenttoamend theHealthActto prohibit the detention of patients and corpses of patientsbyhealthfacilities

ENACTEDby theParliamentofKenya asfollows

1. This Act may be cited as the Health (Amendment) Act, 2025. 2. 2.The Health Act is amended by inserting the followingnewsectionimmediately aftersection7—

Non-detention of patientsbyhealth facilities.

• 7A.(1)A health facility shall not detain apatientorthecorpseofapatientaslien overanoutstandingfeeincurredinrelation totheaccessofservicesinthehealth facility.
• (2)A person in-charge of a health facility which contravenes subsection (1) commits an offence.
• (3) The Cabinet Secretary may make regulationsforrecoveryof feespaidto access services in a healthfacility.

Short title

Insertion ofnew scction 7A in Cap. 241.

MEMORANDUMOFOBJECTSANDREASONS StatementofObjectsandReasons

This Bill seeks to amend the Health Act to prohibit the detention of patients and corpses of patients by heaith facilities.

Article 28 of the Constitution provides that every person has inherent dignity and theright tohave the dignity respected and protected whileArticle39(1)of theConstitution provides that"everyperson has the righttofreedomofmovement".

Article29(a) and (b)of theConstitution on the other hand states that "every person has the right to freedom and security of the person, which. includestherightnottobe-

• (a)deprivedoffreedom arbitrarilyorwithoutjustcause;
• (b)detained without trial,except during astateofemergency,in whichcasethedetentionissubjecttoArticle58;"

At the international front,there are international conventions and instruments which recognize human dignity,freedom, and respect. Article 2(6)of the Constitution stipulates that"any treaty or conventionratified byKenyashall formpartofthelawofKenya under thisConstitution".

Article1lof theInternationalConventiononCivilandPolitical Rightsprovides that no one shall beimprisonedmerelyforinabilitytopay a debt or discharge a contractual obligation.This refers to a situation where someone iscommitted tocivil jailbecauseheis unabletosatisfy a decree.

Article6of theAfricaCharteron HumanandPeoplesRights providesthateveryindividualshallhave therighttolibertyand tothe security of hisperson.Noone may be deprived of his freedom except for reasons and conditions previously laid down by the law.In particular,no onemaybearbitrarilyarrestedordetained.

These international instruments support the protection of fundamental human rights that the right to libertyisinviolableexcept in accordance with thelaw.

Our courts have on numerous occasions been faced with cases on the detention of patients by hospitals for nonpayment of bills. Most courts have insuch instances held theviewthat detentionofpetitionersfor their inabilitytopay theirmedicalbills isunlawful,arbitraryand unconstitutional.

Statement on the deiegation of legislative powers and limitation of fundamentalrightsandfreedoms

TheBill delegates legislative powers to the Cabinet Secretary responsible for heaith to make regulations for recovery of fees paid to access services in a health facility.

TheBill does not limit anyfundamental right orfreedom.

The Bill concerns county governments as it contains provisions relatingtothetreatmentofpatientsandcorpsesofpatientsafteraccessing servicesinhealthfacilities.Paragraph 2ofPartIIof theFourthSchedule to the Constitution designates county health services as county governments'functions.

StatementofhowtheBillconcernsCountyGovernments

TheBillthereforeaffects thefunctionsand powersof county governmentsintermsof110(1)(a)of theConstitution

Statementthat theBillisnotamoneyBillwithinthemeaningof Article114oftheConstitution

TheBill dealswithmattersother than thoselisted in the definitionof a moneyBill under Article114(3)of the Constitution andis thereforenot a moneyBill within themeaning ofArticle114 of the Constitution.

MOGENI ERICK OKONG'O,

Senator.

Dated the 16th July,2025.

PARLIAMENTOFKENYA THE SENATE

SENATEBILLSDIGEST

THEHEALTH(AMENDMENT)BILL,2025 (SENATEBILLSNO.12OF2025)

Sponsor:

Sen. Mogeni Erick Okong'o, M.P

Committeereferred to:

Standing Committee onHealth

Type of Bill:

Ordinary Bill

Date of First Reading:

23rd September, 2025

1.Background

The right to human dignity, freedom of movement, and liberty are fundamental constitutional rights in Kenya.Article 28 of the Constitution safeguards every person right to inherent dignity while Article 39(l) of the Constitution guarantees every person's right to freedom of movement. Article 29 (a) and (b) of the Constitution further provides that every person has the right to freedom and security of the person, which includes the right not to be deprived of freedom arbitrarily or without just cause, or detained without trial except during a state of emergency.

Currently, there have been numerous cases where health facilities have detained patients and corpses of patients as security for unpaid medical bills. Kenyan courts have consistently ruled that such detention for inability to pay medical bills is unlawful, arbitrary and unconstitutionai. For example,the High court in the case of Emmah Muthoni Njeri v Nairobi Women's Hospital [2021] KEHC 8797 (KLR) stated as follows at paragraph 47 of thejudgementTheRespondenthereinis not empowered under thelawtohold any person within the hospitcal for failure to pay medical bills.The Respondent's actionofholding the Petitioner over anunpaid medicalbillmakesit culpablefor illegallydetainingthe Petitioner.Although thePetitionerwasin breach ofhercontractual obligation topayher bill, the Respondent had other options open to it to recover the debt and should not have detainedthePetitioner."

Despite clear pronouncements by the courts over the matter, the practice of detaining patients over unpaid medical bills continues to occur due to the absence of specific legislative prohibition.

Kenya Gazette Supplement No. 120 on 18ih July, 2025 to address this constitutional violation by explicitly prohibiting the detention of patients and corpses by heaith facilities.

2.Purpose of the Bill

The Health(Amendment) Bill, 2025 seeks to-

• health facilities;
• freedom and security of person, and freedom of movement;
• (c) align domestic law with international instruments including Article 1l of the International Convention on Civil and Political Rights and Article 6 of the African Charter on Human and Peoples Rights; and
• (d)provide alternativemechanismsforrecoveryoffeespaid to access healthservices

3.Overviewof the Bill

TheBill introduces a new section 7A to theHealthActwith thefollowingkeyprovisions;

• ·Prohibition of detention of apatient-A healthfacilityshall not detain apatient or the corpse of a patient as lien over an outstanding fee incurred in relation to accessing scrvices in the hcalth facility.
• Criminal offence-A person in-charge ofa healthfacility who detains a patient over an outstanding fee commits an offence under the law.The applicable penalty shall

be the general penalty provided under section 111 of the Health Act Cap 241 which provides that a person convicted of an offence under the Act for which no penalty is provided shall, on conviction, be liable to a fine not exceeding two million shillings or to imprisonment for a term of three months, or both.

• Alternativerecoverymechanisms:The CabinetSecretaryis empowered tomake regulations for recovery of fees paid to access services in a health facility.

4.What are theimplications ofthelaw oncepassed?

Once enacted, the Health (Amendment) Act, 2025 will have significant implications for the healthcare sector in Kenya. Health facilities will be legally prohibited from detaining patients Or corpses as security for unpaid medical bills, with facility managers facing criminal liability for violations. This will enhance protection of patients' constitutional rights to dignity, freedom, and liberty while requiring health facilities to develop alternative debt recovery mechanisms in line with regulations to be developed by the Cabinet Secretary.

County governments will also need to ensure compliance across all health facilities under their jurisdiction and may need to revise their health service delivery policies. The law is expected to reduce healthcare related human rights violations, improve access to healthcare services, and restore public confidence in the health system.

5.WayForward

Whatnext?

Pursuant to standing order 145(5) of the Senate Standing Orders, the Standing Committee on Health shall facilitate public participation and shall take into account the views and recommendations of the public when the Committee submits it report to the Senate.

What isexpected of the members of public?

The members of the public are expected to present their views to the Standing Committee onHealthforitsconsideration

Next steps

TheBill was reada First Timein theSenate on 23rdSeptember,2025.Pursuant to standing order 148(1) of the Senate Standing Orders, the Standing Committee on Health is required to submit its report to the Senate within thirty (30) calendar days of the committal of the Bill to the Committee, therefore, by 22ud October, 2025.

Any comments on the Bill may be submitted to the Office of the Clerk of the Senate, 1st Floor, Main Parliament Buildings, Nairobi, Kenya, through P.O. Box 41842-00100, Nairobi, Kenya or email:clerk.senate@parliament.go.ke and copiedto hcalthcommittee.senate@parliament.go.ke.

Note:

• 1.The Digest reflects theBill as published anddoes not cover anysubsequent amendmentstotheBill.

2. The Digest does not have any official legal status.

3

Annex 3:

Advertisement as published in the Media

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REPUBLICOFKENYA THIRTEENTHPARLIAMENTIFOURTHSESSION

THE SENATE

INVITATIONFORSUBMISSIONOFMEMORANDA

THEHEALTH[AMENDMENT]BILL,2025[SENATEBILLSN0.120F2025]

TimeintheSenateonTuesday.23dSeptember,2025andthereafterstoodcommittedto The Health[Amendment] Bill,2025[Senate BillsNo.12of2025]wasreadaFirst theStandingCommitteeonHealthforconsideration.TheCommitteeisrequiredunder Standingorder455]oftheSenateStandingOrders,tofacilitatepublicparticipationon theBillandto takeintoaccounttheviews andrecommendationsof.the publicwhenthe Committeemakesitsreportto.theSenate.

ofpatientsbyhealthfacilities.TheBillfurtherseekstogiveeffecttoArticles28,29and 39oftheConstitutionregardinghuman dignity.freedom andsecurity ofpersonsand freedom of movement.

Inaccordancewiththeprovisions.ofArticle118of theConstitutionandstandingorder 145[5]of theSenateStandingOrders,theStandingCommitteeonHealthnowinvites interestedmembersofthepublicto submitanyrepresentationsthattheymayhaveon. theBillbywayofwrittenmemoranda.

Thememorandamaybesubmittedtothe Clerkofthe Senate.P.0.Box41842-00100, Nairobi,hand-delivered to the Office of the Clerk of the Senate,Main Parliament October,2025at5.00p.m.

The Bill anda digest that summarizes.thecontents and contextof the.Billmay be accessedontheParliament.websiteathttp://www.parliament.go.ke/the-senate/ house-business/bills.

J.M.NYEGENYE,CBS, CLERKOFTHESENATE.

PO.ox1019-0100ombaseyaTel768-77-444Emakpapnslnoke KENYAPORTSAUTHORITYPENSION SCHEME

NOTICEOFTHEANNUAL GENERAL MEETING 2024 (DBSCHEME)

NOTICE IS HEREBY GIVEN that the 18 Annual General Moeting ofKenya PortsAuthority Pension Pensionersfromallregions,contributing and deferredmembersofKPAPension Scheme(DBScheme)are Scheme(DB Scheme)willbeheld onFriday17 October2025,starting at9.00amatKisumu Port(Pler) requested to attend the Annual General Meeting to transact the following business.

• Readingof the.Notice andAgenda

3. Consideration andAdoption of theMinutesof the Last AGM 2. Opening of the Meeting and Introductions 4. Report by the Chair of theBoardof Trustees 6. Presentationof the Audited Accounts fortheyearendedDecember 31,2024,by the Scheme Auditor 5. Report by theManagingDirector(Sponsor)

• 7:Presentation of the InvestmentReport by the Scheme'sFundManagers

9. Presentationof the Structure of Benefits by the Scheme Actuary.

• Presentation of the Custodial Report by the Scheme'sFund Custodian
• BenefitsAuthority!
• 12.Vote of Thanks
• 11.5 Questions and Answers

IMPORTANTNOTESFORMEMBERS

Identiflcatlon:Members arerequested to bring appropriateidentification documents and tobe seatedby.8:45AM.

Travel Costs:Please note that the cost of travel and attendance isNON-REFUNDABLE.

Access toDocuments:Copies of·the Scheme's AuditedAccounts willbe available-for perusal attheScheme'sregistered offcesorcan'be downloadedfrom theSchemeswebsite atwww kpapension.co.ke..

ByOrder of the Board,

BernardKibet Scheme Admlnistrator

Dated:1Octobor2025

watieno@ke.nationmedia.com

How K0's Sh387b dream crashed Defore takeoff

Anambitiousmultibillion billion)wasbasedoneconomicand an.todominateAfricanskies marketassumptionsthatdidnotma llapsed:leavingthe national terialiseleavingtheairlineburdened rrier-indebt withunsustainabledebtanderoded equity rojectMawingu'sfailure,the Kilavuka-explainedthat:Project Osays,crippledthe airline Mawingu.launched in2012,aimedto dnowwarnsprofitunsus powerhouse with 1igdestinations transformKQ intoa/globalaviation nablewithout freshcapital by2021Howevertheplancollapsed under theweight ofover-ambitious aircraft:acquisitionshigh financ VEGITHINJI, NAIROBI ingcosts.andoverestimatedmarket Project Mawingu,oncebased-onoptimisticassumptions tee has heardthatKenya Airways( parliamentary.commit(KQ)ambitious: 12freightersforcargo.Itwasavision growthprojections Thestrategywastogrowthefleet smostexpensive venturesthat ultionalcarrierbecameone 5.3per cent economicgrowth;and increasing demand fromemerging. ppearingbefore the National uikcarevealedthattheairlinesKifarubutthesetoostruggledunder oximately Sh387bilion(USs3borrowing. mbly's PublicDebt and Priva ionCommittee,KQ CEOAllan itious expansionplan.valuedat telyfailedtotakeoff. KQpursuedotherrestructuringini marketsKilavulatoldMPs theweightofrisinglossesandheavy tiativesProjectSafariandProject Followingthecollapse ofMawingu,

NATIONAI

ernmentpaid banksbetween2017 and2019.

NyaribariMasabaMP DanielMan dukualsopressed forclarity onhow KQintends torepay the estimated Sh70billioninjectedby thegovern ment:warningthat.taxpayersare shoulderingaburdenwithout aclear repaymenttimeline.

Morefunding needed

KQposted arecordprofitofSh5.4 bilionlastyearWill this trendcon tinueandwhenwilltheairlinestop relying on publicfunds?asked MandukuKilavuka-attributedlastyear's

theCabinetapproveda Sh43billion restructuringprogramme.HowevertweenthegovernmentandKQis (USS363milion)government-backed In2022aspartofProjectKifau Ashareholder loanagreementbeworsenedby theCovid-19pandemic due to severe cashflowconstraints,i-reduce dependence on thestate. So far.oniy Shi2.9 billion(S100million)offheprojected Sh5i.7billion (S400million)requiredforfullturnaoftenconvertingdebtintoequity signedwithintwomonthshe added. However,MPsexpressedconcerns turnaround isnotassuredDe Withoutaninvestorcour givinglenders a38percent stake in the airlineAfurtherSh19.69 billion paidonKQsbehal6inJanuary2025 ingovernment-guaranteedloanswas billion(S167-milion)owedto101ocalbankswasconvertedinto equity. "KQcouldn'tmeet-its obligations comparedtotheShi7bilionthegov equityconversionandquestionedthe government'scontinued financial involvement and howthe38percent equity stake ried thetotalvalueofloans advanced KinangopMPKwenya Thukuque ingTreasuryapprovaL spitestrongdemand:we'reoperatingat-80.per-cent-capacity Todatethegovernmenthasinjectd over Sh70bilionintoKenyaAirways. and losingmarket sharehe said withfurtherloan agreementspend igithinyi@standardmedia.co.ke.

ourt orders detention of six sliceofficers over armsring

lirobicourthasordered sixpoliceofficerstheprosecutionhasdemonstrated arealpossi neld for10daysasinvestigatorspursuebilityofinterferencewithongoinginvestigations s ofillegalirearmsandammunitiontrafiftheyarereleased atthisstage,hestated sargued thatfurtherdetentionwaseces-ersfacemultpleallegationsncludingposses inTurkana Thedecisioncameafterpros TheDcLinformed thecourt thatthesixoficfMagistrate.Lucas Onyina granted the ra thoroughinvestigation. sionofammunitionincontraventionofSection 4A(1)(a)of theFirearmsActpossessionofafre tby theDirectorate of Criminal InvestigaCI)and theDirectorof PublicProsecu-commit a felonyunder Section393of the Penal armwithoutavalidcertificate,conspiracy.to PP)to hold the.accused,Charles.Lotira (abrisonofficer),fleli CyrusKisamwa Code,andunlawfulpossessionofgovernment

trolledthekeystoarmourystorescontaininga TheDcIalso alleged thatSangandTonuiconAffidavitsbyCorporal Kimuyurevealedthatfol pistoLmagazines and additionalammunition lowingintlligencereportsrrestwremade inNairobiand Eldoret.

LPoliceStationpendingcompletionofsPolice armoury allegedly transported ammuni Mutonguboth-attached to Nairobi CentraL According.to.court filings,Kisamwaand oficerwastoreceiveanddistributeitinLodwar forresale InteligencefurtherimplicatedEkidor in trafficking amimunitionat LokichogioMarket near theKenya-SouthSudanborder

Officer Kipngetich, serving jnTurkanas transporting1.007rounds of ammunitionin a. armourywasarrestedonUhuruHighwaywhile small Toyota Passo.

Ombeta urged.the court to dismiss.the DCI's requestarguing.theirclientswerenotflight risks andcould be easily.traced.Thematter is further directions.[NancyGitonga] duetobemcntioned againonOctober9,2025for

. uiandIsaacKipngetich,attheCap ithi.MutonguWesley Sang.Paul ations: ruling.MagistrateOnyinaheld thatthe tionhadmetthe.constitutional thresherArticle49,whichensures defendants n'attheirrst court appearanceHe I that the investigating.officer had premedofcharges orreasonsforcontinued Idetention compelling evidence justifying the ridenceincludesballisticanalysisofthe dfirearmandmagazines,digital forenizedmobile phones,tracing of accomNairobiandTurkana,and intentions to dditional exhibits from armouriesThe referencedaffidavits submittedby d29,2025,whichoutlined thescopeof :andwarnedofpossibleinterferenceif ctswere released."Whileitisnot disat the respondents have residences.

REPUBLICOFKENYA THIRTEENTHPARLIAMENTIFOURTHSESSION THESENATE

INVITATIONFORSUBMISSIONOFMEMORANDA THEHEALTH[AMENDMENTBILL,2025[SENATEBILLSN0.120F2025]

The Health[Amendment]Bill,2025[Senate BillsNo.12of2025]wasreada First TimeintheSenateonTuesday23September025andthereafterstoodcommittedto CommitteemakesitsreporttotheSenate. theBillandtotakeintoaccounttheviewsandrecommendationsof the publicwhenthe Standingorder1455]of theSenate StandingOrders,tofacilitatepublicparticipationon.

TheBill seeksto amend the HealthAcf foprohibit the detention ofpatients andcorpses ofpatientsbyhealthfacilities.TheBillfurtherseekstogiveffecttoArticles2829and 39of theConstitutionregarding human dignity.freedom-andsecurityof personsand freedom.ofmovement.

Inaccordancewith theprovisionsofArticlel18of theConstitution and standingorder 1455]of.theSenateStandingOrders,theStandingCommitteeon,Healthnowinvites interestedmembers.of.thepublic.tosubmitany.representationsthattheymayhaveon theBill bywayofwrittenmemorandar

The memoranda maybesubmitted totheClerkoftheSenate.P.0.Box41842-00100, Nairobihand-delivered to the Office of theClerk of the Senate.Main Parliament Buildings, Nairobi oremailed toclerk.senate@parliament.go.keandcopiedto healthcommittee.senate@parliament.go.ketobereceivedonorbeforeFriday.17h October,2025at5.00p.m.

The Billanda digest thatsummarizes.the contentsand contextof.the Bill may be accessedon.the Parliamentwebsiteat:http://www.parliament.go.ke/the-senate/ house-business/bills.

J.M.NYEGENYE,CBS," CLERKOFTHESENATE.

profit toa combination of factors includingcarrying5:3millionpasrevenuarelativelystableexchange sengersgenerating Sh188billion in rateand the effectsofProjectKifaru. Proftabilitydoesnotguarantee. sustainabilityhe saidToremain viable,we-needsignificantcapital injection or a'strategic-investor.to

hich have alreadybeen searched:I find

Annex 4:

Matrix on Stakeholder Submissions

THE SENATE STANDING COMMITTEE ON HEALTH

STAKEHOLDER VIEWS ON THE HEALTH AMENDMENT BILL, 2025

(SENATE 12 0F 2025)

| COMMITTEEOBSERVATIONS | (1) The Ministry of Health opposes the Bill, arguing that mortuary services are billable and therefore charging of be not criminalize mortuary services but actof detaining a patient or a corpse of a patient for non-payment of medical criminalized. The Bill does 1 cannot criminalizes the [2021] KEHC 8797 (KLR). services Women's rather, these Rejected | by the High Court in the case of Emmah Muthoni Njeri v Nairobi Hospital (2) Hospital detention directly conflicts Healthcare from accessing needed services due to fear of detention, contradicting patient-centered quality care, and with Universal | |-------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | PROPOSAL|RATIONALE | and are therefore subject to d se sr s e o sn pe s be already for health therefore tariffs social are provided for under the services, cannot criminalized as proposed. the under services these (a) Mortuary healthcare billable, (b) Further, such | b The issue of non-payment of fees should may that be handled administratively. financial burdens experienced. | | | the Delete clause | | | STAKEH OLDER | Ministry of Health | | | CLAUSE | Clause 7 | |

financial

(3) The Ministry correctly notes that

(4) The proposed

health facility.

• fees paid to access services in a

make regulations for recovery of

empowers the Cabinet Secretary to

to detention.

prevent the very situations that lead

Insurance

policy framework (Social Health

justifiable. The Ministry's

making

bills should decrease significantly,

insurance, the incidence of unpaid

services are covered by social health

rather than undermine the Bill.If

This observation actually supports

burdens that may be experienced.

SO astoalleviate any financial

the Social Health Insurance scheme

under the tariffs for healthcare under

and mortuary fees is already covered

charging medical fees for patients

sufficient means to pay.

from seeking care if they lack

deterrent effect, preventing paticnts

• hardship.

exposing

Fund) is designed to

detention

patientso

Section

even

7A(3)

own

less

| This provision explicitly protects facility interests by providing a fee recovery. Administrative procedures for framework regulatory | or (a) The High Court in the case of Emmah Muthoni Njeri v Nairobi Hospital has of patients for recovery of medical fees (b) While freedom of contract is a well- known concept of contract law, no n detention of a patient for failure to be (c) Article 11 of the International Covenant on Civil and Political prohibits imprisonment for inability to fulfill a already ruled that detention would addressed through subsidiary. [2021] KEHC 8797 (KLR) Rights (ICCPR) further fees is unconstitutional. unconstitutional. medical Women's pay Rejected | |------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | | s d sind () 28, 29, 39: dignity, security, movement) facilities' (b) While patient rights are provided for in the primary legislation, health facility rights creating a hierarchy of laws that devalues without government subsidies, relying entirely on n sd n bills directly threaten operational capacity salaries, equipment maintenance, medicine stocks, and emergency readiness. There is also a risk of facility closures due to revenue enterinto collect fees for services rendered). ns Ked on K se yns but fails to protect health operate facilities facilities (d) While the heath provider interests. (c) Private losses. | | | the 10 an provision that for criminalizatio n of patients who refuse to to the to under Article 40ofthe Constitution. alternative provides Delete clause provide services order protect hospitals right property the pay | | | Aga Khan Services Health |

4

(e) Court petitions are used tactically with

consentto

referral and the patients/next of kin must

resources is a legitimate ground for patient

Guidelines

Sector

afford. Further, under the Kenya Health

arrange

responsibility to enquire about costs and

Charter

the Kenya National Patients' Rights

relationships and freedom of contract.

undermines

since facilities lose all leverage and also

incentive for intentional

The

additional legal expense.

costs

even successful court cases rarely award

unenforceable “paper judgments” and that

Civil

causing

media publicity to pressure facilities,

abandoning legal proceedings.

• discharge/release then leave the country,

• who obtain court orders for

is even worse in the case foreign patients

• decline transfers to affordable facilities. It

amendment

to facilities, leaving

reputational damage.

2023

court

2014,

Referral

existing

patients

judgments

creates

lack

Implementation

of

non-payment

them with

have

contractual

financial

Further

passive

remain

the

(e) Exempting private health facilities private. whether the facility should be prohibited regardless of WHO position is clear that detention based on facility ownership. and cannot be selectively applied Constitutionalrightsare universal hospitals constitutional rights apply in public create atwo-tier system where from Section 7A application would but not private is public or ones. The

• (d) If patient refuses transfer against

remains civil debt recovery. right to detain. The facility's remedy documented,but it does not create a medical advice, thisshouldbe

Most of these patients however refuse to (h) The stakeholder cited the following four be transferred to other hospitals.

Nairobi Women's Hospital where the Court s on noted patients cannot expect free of guise “under Kilundo care (i) Gideon private

Omusulawhere the Court allowed financial incapacity and therefore lack of financial capacity is valid referral on based (ii) Karen transfer

(ii)Ludindi Venant & Anor vs Pandya Hospital [1998] eKLR, where the condemnedthe the ordered 7 even nevertheless court,

undertaking in damages limited to

6,000,000/~ pending the

hearing and determination of that

(iv)Bldemi Steven Atuli Okorodudu v where the Court requiring rightsby Khan balanced Aga

provide

constitutional protection"

01

ground.

plaintiffs

5

Kshs.

suite.

cases-

(i) The stakeholder therefore requests for the

following interventions --

#

(i) Exempt private health facilities

(iv) Amend to criminalize patients whofail to adhere to their contract

(ii) Delete the clause that provides the Cabinet Secretary with the powers

of contract.

facility as it goes against freedom

of fees paid to access in a health as

to make regulations for recovery

health facility.

enforceable undertaking to the fully paid or provide an acceptable facility will ensure that the fee is accessofservicesinahealth fee incurred in relation to the whomtherewillbean outstanding health facility who in respect to "A patient or client or user of a

included to provide --

clause, a new subsection should be

Should the committee retain the

their unique funding model

from Section 7A application given

deposit for a foreign national. passport surrender or security

| | Rejected | Rejected | |--------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | to pay fees or honor their payment undertakings. | (a) The provision allows for the Cabinet s counties yet health is a devolved function. (b) COG however, noted that the other provisions are okay. | following (a) The preamble of the Bill needs to be made for non- s ro nd (b) There is need for the definition of the term all circumstances foreseen are captured in the There is need for clarity as to whether the is only for detentions arising out of emergency care or in all instances since the amended sectiondeals Suggest a redress mechanism for kins for that detention the ensure suggests against 01 criminalization detained patients stakeholder legislating "detention" enhancements- expenses. Bill. The | | | the provision that the to fees secretary regulations Delete allows cabinet make uo | Enhancement of the Bill. | | | Council of Governors County (COG) | Legal and Kenya Ethical Issues Network (KELIN). |

| outstanding the of payment of the modalities shall agree on deceased patient and/or a discharged and the kin of "the provide further Amend shillings. two exceeding of a fine not facility million the that | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | Gender and National Bill Amend the | |----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|--------------------------------------| | | fortheRejected | fortheRejected | fortheRejected | fortheRejected | fortheRejected | fortheRejected | fortheRejected | fortheRejected | fortheRejected | fortheRejected | fortheRejected | fortheRejected | fortheRejected | fortheRejected | fortheRejected | fortheRejected | fortheRejected | fortheRejected | fortheRejected | fortheRejected |

NGEC/CS/LEGAL/VOL.1I(31)

Mr. Jeremiah. M. Nyegcnye, CBS,

The ClerkoftheSenate Clerk's Chambers Parliament Building P.O. B0x 41842-00100 NAIROBI

Clerk.senate@parliament.go.ke

14th October 2025

nr. Lgegenge, CBS

Dear

COMMENTS ONTHEHEALTH(AMENDMENT)BILL,SENATEBILLS NO. 12 OF 2025

Refereice is macie toyour call for the submission of memoranda on The Health (Anendment) Bill 2025

Secticn8(b)oftheNationalGenderandEqualityCommissionAct,CAP7K,mandatesthe (omrissionto,monitor,facilititendadviseontheintegrationoftheprinciplesofequality andfrecdorfromdiscriminatoninallrationalandcountypolicies,laws,andadininstrative reguiationsinallpublic andpriuateinstitutions,

In line: with ils mandate, the Corrnission presents to you a memorandum analyzing the proposed bill arid making proposals where necessary.

Dus

Yours

Nic:keauedeul

151107207

ENATE

Purity Ngina, PhD, MBS COMMISSIONSECRETARY/CEO

M.Renqera

Kiuelly deal.

National Gender and Equality Commission

1stFloor,SolutionTechPlace,5 Longonot Road,UpperHill,Nairobi P.O.Box 27512-00506 Nairobi,Kenya.

Landline:+254(020)3213100

Mobile:+254(020)375100

TollFree:0800720187

Email: info@ngeckenya.org

www.ngeckenya.org

| JUSTIFICATION/COMMENTS | 01 include private institutions. For emphasis “Facility" The Health Act interprets | The amendment will ensure that both private and public facilities do not demand topatients conditions, and that they do not detain patients who emergency conditions, died at the facility (corpses). emergency under under admitted admitted were | In the case where the patient is or the the process to claim the charges incurred will be initiated Fund, SocialInsurance of | |--------------------------------------------------------------------|--------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | | | Propose to amend Clause 7A(1) as follows-; | 7a(2) by attaching a facility commits an offence if the person detains or permits the detention of a patient or the body enforcing settlement of pending bills, and is purposes penalty to the offence as follows- personfor to amend deceased Propose H | | Act is amended by immediately after section 7- The Health Clause 2 | by patients of Non-detention health facilities | 7A. (1) A health facility shall not fee incurred in relation to the access of services in the health facility. | (2)A person in-charge of a health facility which contravenes subsection (l) commits an offence. |

| These amendments a seek to ensure that protected | | |---------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------| | liable on conviction to a fine not exceeding Further amend as follows two million shillings | patient and/or the deceased shall agree on the modalities of payment of the outstanding charges |

General Comments

the sponsor of the Bill to consider the consolidation of the two Bills.

0 4 NOV 2025

COUNCIL OF GOVERNORS

WestlandsDeltaHouse2naFloor,WaiyakiWay. P.O.B0X40401-00100, Nairobi.

Our Ref:COG/6/40 Vol.110 (22)

29th October 2025

Jeremiah Nyegenye, CBS

Clerk of the Senate MainParliament Buildings NAIROBI

Dear Clerk,

BILL,2025

The Council of Governors appreciates the existing collaboration with the Senate through the Standing Committee on Health, which is established pursuant to standing order 228 (3) and the Fourth Schedule of the Senate Standing Orders and is mandated to consider all mattersrelating to medical services,publichealth and sanitationto study andreview all the legislationreferred toit.

Inviewof the above,the Council hasreviewed andpreparedsubmissions onthe Health (Amendment) Bill, 2025 which seeks to amend the Health Act, 2017 to prohibit the detention ofpatients andcorpsesofpatientsbyhealthfacilities.

The purpose of thisletter,therefore,is to submit the attached memorandum foryour consideration.TheCouncil remains available forfurther discourse on thesubject.

Please accepttheassurance ofourhighestesteem andconsideration.

Yours sincerely,

Mary Mwiti,EBS ChiefExecutiveOfficer

lend

0 4 NOV 2025

DEPUTY CLERK

Tel:(020)2403314,2403313

E-mail: nfo@cog.goke

COUNCILOFGOVERNORS

LEGISLATIVE MEMORANDUM ON THE HEALTH (AMENDMENT) BILL, 2025

:O1

THESENATEHEALTHCOMMITTEE

THECOUNCILOFGOVERNORS From:

T'he Council of Governors, and the County level;

Aware of the need for coordination and consultation between the National Government and County Governments to ensure that The Council hereby notes as follows on the HEALTH (AMENDMENT) BILL, 2025 (the Bill):

A.General Comments:

The Health (Amendment) Bill, 2025 seeks to amend the Health Act, 2017 to prohibit the detention of patients and corpses of

B.Comments on Specific Provisions:

| Comments | Amendment is okay. | |------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Provision | (1) A health facility shall not detain a patient or outstanding fee incurred in relation to the access of services in the health facility. health facilities Section7A | | NewSection | patients by Non-detention of |

| Amendment is okay. | This amendment should be expunged from the Bill because it empowers the Cabinet Secretary to micro- to with regards County Governments manage | |------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------| | contravenes subsection (1) commits an offence. | make Secretarymay access services in a health facility. Cabinet (3) The |

Recommendations

provisions of the Constitution on devolution and particularly as far as the constitution provides for the Health function.

OurREF:2/SN/2025

Clerkof the Senate Senate of Kenya MainParliamentBuildings P.O.Box41842-00100 NAIROBI

YourREF:TBA

(DS Advance copy by email:clerk.senate@parliament:go.ke

Dear Sir,

RE:TheHealth(Amendment)Bill.2025(SenateBillsNo.12of2025)

TheKenya Legal & Ethical Issues Network on HIV and AIDS(KELIN) is a human rights nonKenya. KELIN does this by providing legal services and support, training professionals on human s s conducting research, and influencing policy that promotes evidence-based change.

Wewrite in response to theinvitation for submission of written memoranda to TheHealth (Amendment)Bill, 2025(Senate Bills No.12of 2025), dated 6 October 2025.Kindly find enclosed our writtenmemorandum.Wepray that our comments are considered.Weare available for further engagement with the Standing Committee on Health in the Senate on the subject matter.

AllanMaleche ExecutiveDirector

15 0C1 2025

Karen C,Kuwinda Lane,Off Langata Road. PO.Box112-00202KNHNairobi,Kenya

@KELINKer

3Mr·Ringerg

Date:15October2025

2 1:OCT 2025

GENERAL COMMENTS:

proprietors of health facilities. The Preamble of the Bill needs to be made clearer to address the specific objects for legislating against detention for nondetention under the Public Health Act to prevent the spread of infectious diseases. There needs to be a definition of the word detention to ensure that all circumstances foresen are captured by the Bill. prohibition for detention ought to apply to allcircumstances including and beyond emergency health circumstances. aadsa sa a dn s u s a a a pas p a

SPECIFICCOMMENTSPERCLAUSE:

Section Preamble Preamble financial reasons.

Suggest a rephrase of the preamble to indicate that the Amendment is for detention for

An Act of Parliament to amend the Health Act to prohibit the detention of patients and corpses

of patients by health facilities for financial reasons.

reasons because there is no mention in the section on interpretation, neither is there a working definition in Constitution of Kenya,2010 or the Health Act,2017. discharge is clinically indicated, or refusing release of bodies of deceased patients, for reasons of non-payment in part or in full of hospital bills or medical expenses.

Clause 2(7A)

1.Section 2 of the Health Act- Definition

| Suggest the prescription of a fine for the offence created. | A person in charge of a health facility which contravenes sub-section 1 commits an offense and | remains for financial reasons. All healthcare providers, whether in the public or private sector, shall have the duty—to avoid detention of patients or their rermains forfinancial reasons. Suggest the establishment of a redress mechanism for kin of patients who have been | |---------------------------------------------------------------|--------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | | Clause 2 (12A) | | | Health Act- Offences | 3.Section 12 (2)(d) of theHealthAct- | Duty of Healthcare providers |

"By hand delivery & Email"

OurRef:LD/AKHSK/B.01

TheOfficeoftheClerkoftheSenate MainParliamentBuildingsNairobi, P.O.B0x41842-00100, Nairobi

Aga Khan Health Service,Kenya

140CT2025

Date:October14,2025

Email: clerk.senate@paliament,go.ke healthcommittee.senate@parliament.go.ke

Attention: J.M.Nyengenye,CBS.

Dear Sir,

Re: MemorandumontheHealthAmendmentBill,2025[SenateBill.No.12of2025] WerefertotheaboveandtothenoticeforcommentsthatwasbytheClerkoftheSenate.

Part1.Introduction.

The Aga Khan Health Service,Kenya is a company limited by guarantee [hereinafter referred to as, interchangeably as,"the Aga Khan Health Service,Kenya,"or "the Company,"] which runs three [3]hospitals inKenya namely,the AgaKhan University Hospital,Nairobi,the Aga Khan Hospital, Mombasa and theAgaKhan Hospital,Kisumu.One ofthe corevaluesofthe companyistomake high caliber health and medical education accessible to all. To achieve the foregoing, in addition to the saidthreehospitals,thecompanyrunsseveraloutreachclinicssituatedinmanypartsof the country.

It hasbeen noted bytheCompanythatvia theHealthAmendmentBill,2025[SenateBill No.12of 2025][hereinafter referred to as,"the Bill,"]an amendment has been proposed in the Health Act by

Section7A[1]"A healthfacility shall not detainapatientor the corpse of apatient as lienover an outstandingfeeincurredinrelationtotheaccessofservicesinthehealthfacility.

Section7A[2]Aperson in-chargeofahealthfacilitywhichcontravenessubsection[1] commits an offense.

Section7A[3]The Cabinet Secretary may make regulations for recovery of fees paid to access servicesinahealthfacility."

ThismemorandumisherebysubmittedpursuanttoArticle118[1][b]of theConstitutionwhich providesthat:-

"Parliamentshall..facilitatepublicparticipationandinvolvementinthelegislativeandother businessofParliamentanditscommittees."

TheproposedamendmentseekstogiveeffecttoArticles28,29and39oftheConstitutionwhich welcome,thereisnoproposedprovisionthatwouldgiveeffecttoArticle40oftheConstitution regardingprotectionoftherighttopropertywhichwouldinherentlyalsoprotecthealthfacilitiesand Memorandum.

relegatedtoregulationstobeputinplacebytheCabinetSecretaryin-chargeofhealth.

Part2.CurrentSituation

• i. PrivatehealthfacilitieslikethoseundertheAgaKhanHealthService,Kenya,shoulderaquiet but heavyresponsibility.Everyday,they opentheir doors topatients in need,oftenlong beforepaymentis certain.Unlikepublichospitals thatrelyongovernmentfunding,these facilitiessurvivemainlyonwhatpatientsareabletopay.Thatincomekeepsthelightsonin operatingtheatres,salariesflowingfordoctors andnurses,medicinesstockedonshelves, andequipmentfunctioningforemergenciesthatcannotwait.Whenbillsgounpaid,the impactisimmediateandreal,itisnotaboutprofit,butaboutwhetherahospitalcankeep servingthenextmotherinlabour,thenextchildneedingsurgery,or thenextpatient in distress.Sustainingqualitycareundertheseconditionsisadelicatebalancebetween compassionandsurvival.
• ii. Forservicestobeprovidedtopatients,contractualengagements areeitherdirectlyentered orimpliedlyenteredbypatientsandtheprivatehealthfacilitieswhereinserviceswillbe renderedforafee.
• ili. familiesrefusetopaybillsandortoconsenttotransfers;andwhentheyarelaterdischarged ordie,attemptsaremadetoforcefacilitiestoallowthemtowalkscot-freeandorcollectthe remainsoftheirlovedoneswithoutmakingpaymentsorprovidingfeasiblesecuritiesor enforceableundertakings.
• iv. The foregoing is exacerbated where the patients involved are foreigners who after seeking rendered andoronce theymove to the Constitutionaland HumanRightsDivisionoftheHigh Court and obtain orders to be discharged and or corpses to be released to the families, they promptly leave the country and their legal representatives file notices to cease from acting forthemandorabandonthepetitionsincourtsalltogether.

• V. Thisplacesprivatehealthfacilitiesinanextremelydifficultposition,tornbetween compassionandsustainability.Whenfamiliesdeclinetosettlebillsorhonorrecommended transfers,hospitalsareleftbearingsubstantial,unrecoverablecosts.Yet,whiletheymust upholdthedignityofthedeceasedandthegriefoffamilies,theyalsohaveadutytoremain operationalforthecountlessotherpatientswhodependonthem.Thechallenge,therefore, isnotbornofinsensitivity,butofagenuinestruggletobalanceempathywiththe responsibilityof keepingessential healthservicesrunning.

2. Vi. Inmostinstances,forprivatehealthfacilitiestosuccessfullytransferpatientswhoare unabletopaybillstopublicfacilitiesoffacilitiesoftheirchoice,theyareforcedtofile petitionsbeforetheConstitutionalandHumanRightsDivisionoftheHighCourt.If successful,thesaidcourtonlyissuesordersallowingthetransferstobeeffectedanddoes notawardcostsleavingafurtherexpenseinformoflegalfeesandcourtfilingfeesonthe privatehealthfacilities.

• vii. Further,manyaretheinstanceswhereinpatientsandorfamiliesofdeceasedpatientsoften declinetooffersecuritiesorenforceableundertakingstohealthfacilitiesandorgenerally enteragreementsonmodalitiesofpaymentofoutstandingbills.Instead,theyoftenproceed tofilepetitionsbeforetheConstitutionalandHumanRightsDivisionoftheHighCourt privatefacilities.Asthey employ thistactic,they often eitheralsoallege negligenceonthe partofthoseprivatehealthfacilitiesandorensurethatthepetitionsarewidelypublicizedin thepress[creatingreputational damage]and inthesocial mediasoastoexertpressureon againforcedtoincurlegalcostssincetheConstitutionalandHumanRightsDivisionofthe High Courtwould hardlyawardcostsevenwherepatients andorfamilies arefinallydirected corpses.
• vili. EvenwhereprivatehealthfacilitieshavefiledsuitsintherelevantcourtssuchasintheCivil DivisionoftheHighCourtseekingordersforpaymentofoutstandingbillsandororders seekingtoallowthemtodisposeofcertainsecuritiessuchastitlesofparcelsoflandleft behindsoastorecovercostsincurred,morethanoften,ifsuccessful,thejudgmentsremain aspaperjudgmentswhichcannotbeenforced.
• ix. Theabovegoestoshowthat,therearenoeffectivemechanismsforenforcementofpayment outstandinghospitalbills.Mostprivatehealthfacilitiesareoftenfacedwithriskofclosure duetorevenuelosses.TheAgaKhanHealthService,Kenyahascontinued tobeunable to enforcepaymentofpendingbillsduetoamyriadoffactors.

Part3.Recommendations.

• i. Theproposedamendmentintrudesthefreedomofparties[patientsandprivatehealth facilities]toentervoluntarycontractualrelationships.The amendmentsgiveeffect to constitutionalprovisionsnamelyArticles28,29and39oftheConstitutionthatfavorpatients butfailtoincludeamendmentsthatwouldalsopromotetheimplementationofArticle40of theConstitutionwhichinthecircumstanceswouldspeakonbehalfoftheprivatehealth

facilities.Tothatendthecompanyismindedopposestheamendment.

• ii. Thereisneedtofactorinhowpublichealthfacilitiesfundtheiroperationsandhowprivate healthfacilitiesfundtheiroperations.Whilepublichealthfacilitiesreceivesubsidieswhich often actassafetynets,private healthfacilitiesdonotreceivesuchsubsidies.Theforegoing coupledwithinsufficientrecoverymechanisms,exposesprivatehealthfacilitiestolossof revenue whichwill have a spiraleffectof creatingchallengesrelatingto;inabilitypaymedical professionals'salaries,inability toinvestinequipmentandinfrastructure and inability to maintainqualityandspecializedservices.Consideringtheforegoing,theamendmentshould notbeallowed andifit isallowed,asectionshouldbeincludedexemptingprivatehealth facilitiesfromtheapplicationofthesection7AoftheBill.
• ili. Theproposedamendmentcreatesapassiveincentivetopatientsandfamilies ofsuch patientstointentionallyfailtopayfees[bills]relatingtoaccesstoservicesrenderedinhealth facilities.Thisisbecausepatients andortheirfamilieswould startrefutingtopayfeesfor accesstoserviceswhileknowingtoowellthathealthfacilitieshaveverylittleornoleverage in thecircumstances.Healthfacilitiesmustalsobe allowedsomeform ofinstant leverage. In lightof theforegoing,the amendment shouldnotbeallowed.
• iv. If theHealth Committeeof the Senate[hereinafter referred to as,"the Committee,"] acceptstheproposedamendment,itshouldalsoconsiderbalancingtherightsofpatients as wellas those ofprivatehealthfacilities.Indoing so,theCommittee should expressly providefortherightofprivatehealthfacilitiestotransferpatientswhoareunableorunwilling tomeettheirfinancialobligations,andtoensurethatmechanismsareinplacetofacilitate paymentorrecovery of costs due tosuchfacilities.Suchmechanisms may include the establishmentofagovernment-backedmedicalindigentfund tooffsetbillsforgenuinely andcost-sharingbetweenprivateandpublichealthfacilities.

4. V. 5. a.UndertheKenyaNationalPatients'RightsCharter2023at Chapter1[4]itisprovided as follows:-

"Everyperson,patientorclient,hasa:-therighttochoose a healthprovider.

Apatient'srighttoaccessahealthproviderofhischoiceshallnotbeunduly restrictedbythirdpartiessolongastheproviderofchoiceisqualified,registered, treatmentfortheparticularailmentorillnessandaslongasthatchoiceisacceptable inmedicalandethicalstandards."

• b.Under theKenyaNationalPatients'RightsCharter2023at Chapter2[10]it is providedasfollows:-

"Everypatienthasthefollowingresponsibilities:-

isequallyentitledtoitsrighttopropertyandunderthesecircumstancesthe courtisunderadutytobalancebothrightssoastodispensejusticeforboth underArticle29and39oftheConstitutionarenotabsoluteandcannotunder Article42[1][b]beenjoyedattheexpenseof thefundamentalfreedomsof others.Article24[1]oftheConstitutionstipulatesasfollows:"Arightof fundamentalfreedomintheBillofRightsshallnotbelimitedexceptbylaw andthenonlytotheextentthatthelimitationisreasonableandjustifiablein anopenanddemocraticsocietybasedonhumandignity,equalityand freedomtakingintoaccountallrelevantfactors,including,theneedtoensure notprejudicetherightsandfundamentalfreedomsofothersand.."Inthe hewillberequiredtosettlethehospitalbills.Therespondentperformedits partofthebargainingbytreatingthe2ndpetitioneruntilheattainedfull recovery...whileitistruethattherelationshipwasacontractualoneforwhich therespondentshouldpursueotherlawfulmeansofrecoveringthedebt otherthandetainingtheirformerpatient,thiscourtisoftheviewthatitdoes notaugurwellforthedispensationofjusticeforpersonstowalkintoprivate undertheguiseofconstitutionalprotectionoflibertyandfreedomof movement."

• KarenHospitalvMichaelOmusula[Beingsuedasthenextofkin, representativeandhusband/spouseofJakylineNelmaMutaki[2021] KEHC622[KLR].

Inthiscasethecourtobservedthat:-

"IntheInstantPetitionithasbeenurgedthatapatientafteremergencyis supposedtobereferredtoahealthfacilitywithintheirfinancialcapacity.This contentionhasnotbeencontroverted.UnderClause2.4ofKenyaHealth SectorReferrallmplementationCondition2014,listslackoffinancial capacityasagroundforreferralofpatients,whereasClause3.3makesit instantPetition,thepatientisincapacitatedandcannotgiveconsentsavethe nextofkinherein,theRespondent,herhusband.Thepatienthereinhasan outstandingHospital bill of Kshs.23,700,549.00whichtheapplicant

toprovidehisconsent,asthepatienthereincannotgiveherinformedconsent forbeingincapacitated.Hefurtherclaimsthehospitalhasnotexplained succinctlythereasonforintendedreferral,thechoiceofthedoctororfacility, theexpectedcostsofreferralandpossibleoutcomeofthereferral.