NHIF urged to consider covering a palliative care burdening ill, kin

Members of the public walk past the National Hospital Insurance Fund building headquarters in Upper Hill, Nairobi. [Elvis Ogina, Standard]

Dominic Mwangi supports himself with a rope to wake up from his bed after he was diagnosed with prostate cancer three years ago. Mr Mwangi, 69, from Mukurwe-ini, Nyeri County depends on his 76-year-old elder sister for care.

Though he has a  National Health Insurance Fund (NHIF) card, the scheme does not offer palliative care, forcing him to seek help at the Nyeri Hospice, whose nurses supply him with medicine at least twice in a week. They also dress his wounds besides offering spiritual and psychosocial support.

“We spend sleepless nights praying for my uncle to have him relieved of pain,” Ms Nancy Wachira, Mr Mwangi’s niece, explains. “It is worrying that his condition worsens every day.”

Controlling pain

The palliative care helps in controlling pain and other infections and “though my uncle’s condition is yet to improve much, he is positive and lives comfortably,” adds Ms Wachira.

Ms Eunice Nderitu, a palliative care nurse at Nyeri Hospice, says a patient’s family members are also included in the psychological support as they are equally affected, but laments that most families have been leaving “their loved ones under the mercy of nobody.”

Ms Nderitu adds: “We guide them (families) through anticipatory grief and after a patient dies we counsel the family on how to deal with grief.”  

Like Mr Mwangi, majority of terminally ill patients cannot access palliative care with NHIF.

Take Mr Eliud Wambugu, 76, for instance. He depends on relatives and friends for financial support to buy painkillers like morphines since he was diagnosed with colon cancer 30 year ago.

Mr Wambugu spends about Sh11,000 on medicine and Sh5,100 on regular check-ups every month.

He says: “The prohibitive costs of managing the disease made me join a palliative group, where we mobilise well-wishers to offer medical and other psychological support.”

This has improved the quality of his life, he says.

Mr Wambugu uses colostomy bags and imported ones range from Sh800 to Sh1,000, and those supplied by Kenya Medical Supplies Authority (KEMSA) cost between Sh100 and Sh300.

“I have modified a paper bag to wear, because I cannot access medicines and also buy colostomy bag,” said Mr Wambugu.

The cost of the bags went up since the outbreak of Covid-19. This alongside shortages. Nyeri Hospice Chief Executive Mr Stephen Musya says the bags are also highly taxed.

At least 150 patients at the Nyeri Hospice use colostomy bags.

Mr Elisha Yogo, a 58-year-old police officer in Oljororok, Nyandarua County, accesses palliative care at the Nakuru Hospice after surviving cancer of the colon.

Mr Yogo, the chairperson of the cancer unit, says: “It is not easy to manage a cancer patient, but when they meet, they encourage each other, a process that helps in healing by accepting the condition.”  

Mr Yogo says few believe he has cancer “until I show them the stoma.”

 Nakuru Hospice founder, Ms Elizabeth Ndung’u says financial constraints is one of the biggest challenges facing patients as cancer drugs are expensive, with pain relievers going for up to Sh20,000 and most patients can hardly afford them on top of chemotherapy and radiotherapy sessions expenses.

“The government should subsidise cancer therapy services for affordability and accessibility,” pleaded Ms Ndung’u.

Mr Musya regrets that despite high demand for palliative care, majority of patients do not have health insurance and NHIF should consider including palliative services, especially oncology services, in the health scheme.

Mr Muasya argues that with devolved units, counties should support palliative care centres with essential medicines, human resource and outreach programmes.   

As the country gears towards implementation of the Universal Health Coverage (UHC), the Kenya Hospices and Palliative Care Association (KEHPCA) has urged NHIF to consider hospices, other providers of palliation support besides the primary health care provider

Under the NHIF Regulations 2022, the beneficiaries of chronic illnesses can access treatment from public healthcare providers only and KEHPCA executive director Ms Mackuline Atieno says hospices may not be the primary care provider but may provide supportive care while on home care, over chronic illnesses, including treatment and psychological support.

In the proposed regulation, a beneficiary with chronic illness is supposed to access treatment from public healthcare facilities only.

But the association argues that not all hospices in Kenya are public and according to Ms Atieno, NHIF should reconsider special criteria for hospices that may not need all the minimum criterial based on their work.