NHIF must assure Kenyans of accountability

Misgivings abound over the revised National Hospital Insurance Fund (NHIF) deductions that became effective last month after a long legal tussle.

Immediately following the announcement by the government last year that there were plans to adjust the monthly contributions upwards, the Trade Congress of Kenya (TUC-K) went to court to challenge the new rates, arguing that health care was inaccessible to most people, besides the fact that there was no public participation prior to the announcement of the new rates.

It is interesting to note that while TUC-K insists there was no public participation and workers are groaning under the weight of the new rates, the leadership of the Central Organisation of Trade Unions (Cotu) insists workers were consulted at a forum in Mombasa, memory of which remains fuzzy. While unionisable workers have representatives to articulate their concerns, the self-employed contributor was completely left out of the picture, yet going by the amount voluntary contributors are supposed to remit, the assumption is that their monthly income falls between Sh12,000 and Sh15,000.

This assumption is erroneous and unless if the original intention was to phase out the unemployed from NHIF, then a majority of them who are ‘mama mboga’ will regrettably have to leave the scheme. At a time when the government has promised better healthcare for all Kenyans, such an occurrence will not only be unfortunate, but discriminatory. If workers with a steady income are complaining of a deduction of Sh150 monthly, how are the unemployed expected to raise Sh500 monthly?

While the NHIF seeks to widen its base by taxing high earners more, it is possible that it will lose some of its membership while at the same time destabilising the private insurance sector.

The argument is that since NHIF is mandatory, private insurance companies that have been giving insurance covers will lose out when workers avoid double taxation. NHIF limits the choice of hospitals for its members, which by itself is a violation of the freedom of choice. Some of the approved hospitals may turn out to be conduits for corruption.

Still, issues raised by TUC-K over the ability of NHIF to manage the new deductions are valid. Can NHIF be trusted to manage increased contributions amounting to Sh2.3 billion better when it has largely been unable to manage Sh800 million monthly? A pointer to the inability of the insurance fund measuring up comes from the admission by NHIF chief executive officer that it would take at least two months before workers enjoy benefits of the new deductions. It simply proves no serious planning had been done in advance of the increased deductions.

In the past, NHIF has inconvenienced contributors by failing to pay hospitals bills on time, besides having one of the worst records keeping system. It takes inordinately long for contributors to have their money refunded.
Now that the new scheme covers in-patient and out-patient costs, as well as treatment of ailments like cancer and dialysis, will it, given that the number of demands on it will have more than trebled, be able to manage without causing uproar over delayed payments, missing files and records?

Since NHIF has been involved in shady deals in the past, as amply evidenced by the saga of the contract awarded to a non-existent medical facility by the name Clinix, trade unions and the public must be assured that their contributions are safe. One way of doing this is to give periodic audited accounts showing how public money is used and invested.

Additionally, a total overhaul of the fund management, informed by the current government purge on corrupt individuals is an absolute necessity to restore lost confidence.
The fund must also deliver timely and effective health insurance cover to a public weighed down by high hospital costs.