Why civil servant’s medical scheme is not working

By Luke Anami

 It was billed as the best medical insurance scheme the country ever had. Pomp and colour greeted its introduction early this year. Public Service Minister, Dalmas Otieno, even hailed it as the best thing that ever happened in the history of civil service in Kenya.

But barely a year since its inception, teething problems compounded with political interference have rocked the National Hospital Insurance Fund managed Civil Servants Outpatient Medical scheme.

Last week, Union of Kenya Civil Servants — the body that proposed the medical scheme in the first place — said its members were getting a raw deal. And they have now issued a seven-day ultimatum to the NHIF management to put the scheme in order, or they will walk out.

“There are no drugs in government hospitals. Civil servants are now being asked to buy medicine yet the scheme is supposed to take care of the treatment, including administration of drugs,” Tom Odege, Secretary General UKCS says.

“We have been patient with the scheme for the past nine months. Both NHIF and relevant government agencies must address this issues otherwise we are going to mobilise our members to reject this scheme.”

But just what is ailing the scheme?

Problems at the NHIF managed medical scheme for civil servants and police begun almost immediately the scheme was launched in January this year.

First, campaigns to popularise the scheme and explain its benefits to members was not carried out. This denied the beneficiaries ample time to understand, and thereby, embrace the scheme.

The first mistake that the parent ministry, Public Service and NHIF management made was to assign civil servants to specific clinics or hospitals based on their pay points or district of origin.

Specific facility

Civil servants were thus denied the chance to enjoy their scheme away from their respective workstations.

“We have rejected the system which forces a civil servant to receive treatment at a facility assigned to them. Civil servants are very mobile people I don’t see the reason why one should be subjected to a specific health facility,” Odege pointed out. 

Interestingly, the government admits the scheme is facing huge challenges, but denies that civil servants are being forced to seek treatment at specific facilities without their consent.

“Civil servants are allowed to identify a facility of their choice and the issue of being subjected to a specific hospital or clinic does not arise,” Titus Ndambuki, Permanent Secretary Public Service ministry said in an interview with Business Weekly.

Meanwhile, a probe by the Parliamentary Committee on Health unearthed the poor state of medical facilities in the country.

Years of inadequate investment in infrastructure, has left the overwhelming majority of public health facilities in a dilapidated state.

Moreover, the Government controls only 48 per cent of the country’s 7,395 health facilities.

 Though the Committee’s report was later dismissed by Parliament, it made observations that cannot be wished away.

Obsolete

“Given the increases in population and the increases in demand for service, these facilities do not conform to the current infrastructure norms and standards. On average, 50 per cent of the equipment in our public medical facilities and research laboratories are obsolete/unserviceable,” says the report.

“Further, there is shortage of human resources to effectively man these institutions. Kenya has an average of 16 doctors and 153 nurses per 100,000 population compared to WHO recommended minimum staffing levels of 36 and 356 doctors and nurses respectively per 100,000 populations.”

While rejecting the newly published list of NHIF accredited facilities, Odege cited poor facilities and lack of doctors as some of the reasons for wanting to pull out of the scheme.

“In Kisumu, New Nyanza Provincial Hospital, a clinic that was set aside to take care of civil servants, has no doctors manning it. An NHIF facility in Kehancha is in a state of disrepair. Who accredited it?” he asked.

The civil servants have also raised issue with the kind of facilities assigned to them, saying they are below standards required to run the scheme. Those injured and require specialised treatment cannot be transferred to other medical facilities since there are no logistics put in place by NHIF for the patient to seek specialised treatment elsewhere.

“The referral system that would see a civil servant seek further specialised treatment is not working and recently an employee was detained in Victoria Hospital, Kisumu, over a Sh17,000 bill.”

Investigation

In Nairobi, civil servants want to be allowed to seek treatment from Clinix and Meridian that were suspended by the NHIF caretaker committee pending investigations from Anti-corruption agencies.

“Up to now, no one has released any report implicating the two clinics. Our members in Nairobi want to be allowed to seek treatment to a facility close to them that is fully equipped with drugs, medical facilities and staff. These include Meridian and Clinix,” Odege explained.