NHIF suffering crisis of poor management

The National Hospital Insurance Fund (NHIF) management has yet again come up with proposals that run counter to what many people know as the Universal Health Care financing.

Encouragingly, positive strides in medical science have made it possible for people to understand what ails them and to seek relevant treatment from specialised facilities for dialysis and chemotherapy, among others.

While the two may not be exactly easy to manage, some promising gains have been made that save patients long journeys to Kenyatta National Hospital for treatment where, a couple of years ago, there was a two-year waiting list. Through the 2014, Sh38 billion medical equipment scheme, two hospitals in each of the 47 counties were equipped with modern state-of-the-art dialysis and cancer treatment machines.

The nobility of the idea cannot be gainsaid, but it has not achieved one 100 per cent success rate. Some of the machines are reported to have broken down from lack of proper maintenance. In other places, lack of trained personnel meant that the machines did not even get to be tested. The perennial matter of industrial action by medical staff over long periods of time has guaranteed that patients do not benefit even after the National Hospital Insurance Fund expanded its cover to include dialysis twice weekly to make it a little bit more comfortable for patients.

Lifestyle diseases

But while medical advances offer hope, there is an upsurge in the very diseases that are causing concerns. Most have been dubbed lifestyle diseases, and indeed they are; from the foods we eat on daily basis to how we manage our environment.

Negligence by Government institutions has emboldened some industries to discharge industrial effluence into rivers on which both animals and humans depend. Use of herbicides leaves many foodstuffs with heavy metals detrimental to health. Most drugs in the market are not just substandard, they are life threatening. Greenhouse emissions have led to global warming. Warm climate offers good breeding ground for some bacteria and germs that spread diseases.

This demands that medical checkups be enhanced to guarantee early detection, and where possible, early commencement of treatment. Last week though, NHIF sprung a nasty surprise on contributors. Whereas access to hospitals has been unfettered, NHIF seeks to restrict them to just four in a year in one of the worst thought out proposals this century. The only positive thing about NHIF's circular last week was the removal of the restriction on outpatient medical facilities.

While NHIF claims it seeks to deal with fraud in the scheme through the latest proposals, anybody with an understanding of how NHIF has been running, since its inception, would understand this as an attempt to make it possible for a cabal within the top ranks of NHIF to feather their nests without worrying too much. The public is yet to get full disclosure on the 2013 Meridian Medical Centre heist in which non-existent Healthcare outlets fraudulently claimed Sh116. 9 million. A further Sh92 million was lost through the Clinix Healthcare Limited fraud. These frauds were orchestrated by NHIF insiders, not the public.

If all 6.5 million NHIF contributors pay a minimum of Sh500 monthly, that translates to about Sh3.25 billion monthly. By limiting patients visits to hospitals to four in a year, a group of individuals is determined to ensure that a tidy sum of money remains untouched and to which they can help themselves unbeknown to the public. It is understandable that companies diversify and re-invest, but the business of NHIF is to guarantee good health, not engage in other business. It is preposterous for contributors to religiously pay monthly premiums yet be 'permitted' to fall sick only four times in a year. With such myopia on the side of policy makers in the health ministry, Kenyans should not be saddled with an institution that is of little value to them.

The increase in premiums from Sh450 quarterly to Sh500 monthly was ill advised. Parliaments call to bring the amount down to Sh300 to attract as many contributors as possible fell on deaf ears. In 2016, NHIF printed pamphlets that indicated dental health was part of the cover and when I personally made a follow up, I was informed the pamphlets had been a printed in error. The acquisition of university education means children as old as 23 years are still dependent on their parents for everything. Why are they not allowed to enjoy their parents protection under NHIF?

Management changes

Clearly, NHIF is not responding to the needs of beneficiaries. It is not even adapting to the changing market dynamics, and neither does it promote the aspirations of universal healthcare with a view to facilitate access to affordable, sustainable, equitable quality social healthcare. NHIF should not just be made more accountable, the fumbling political managers threatening its efficiency should be shown the door.

Mr Chagema is a correspondent at The [email protected]