Mexico experience provides vital lessons in provision of healthcare

By Anyang’ Nyong’o

The National Hospital Insurance Fund (NHIF) is moving in the right direction and deserves congratulations.

Lessons learnt over a 20-year period are now being put into practice. The journey has been long, detractors too many but the steadfast manner of pursuing the common good by the committed is now paying off.

More precisely, the recent two evaluations by Alexander Forbes and the International Finance Corporation (IFC) came in very timely. The recommendations are bearing fruits.

But we need to go further and ensure that each and every corporate sector, each and every union or association bringing together a large number of employees and each and every group where people come together to pursue common interests — be they material or spiritual — is given social health insurance coverage.

In that regard let us remember, for example, the University Academic Staff Union; the Kenya Medical Association; the Medical Practitioners, Pharmacists and Dentists Union; the National Council of Churches of Kenya; the Catholic Secretariat; the Supreme Council of Muslims; the Kenya Amateur Athletics Association and many others.

As a body crusading for social health insurance, the message of the products NHIF is now offering must reach all these groups and many more.

The poor must not be left out: those who are unemployed or have no means of earning any meaningful livelihood whatsoever.

These are the people we usually call indigents, whether they live in rural or urban areas. Their social wellbeing is our concern as a nation in the spirit of mutual social responsibility.

It is our proposal that the Government takes care of the social health insurance of indigents as part of the national social protection programme. Mexico has done it and has done it very beautifully. Mexico is a developing country like us.

Although it has tremendous oil resources, that itself should not scare us.

Taiwan and Israel, which do not have oil resources, also have such social protection programmes for the poor.

What did Mexico do? She set up a special scheme for the poor called El Seguro Popular, or popular security. In order to qualify to be covered one must prove the reality and extent of poverty.

First, one must not be covered under any other health insurance scheme. Second, one must register with the nearest public health facility where one lives or works as a casual labourer. These facilities have detailed forms, which will record all existing sources of livelihood of the applicant.

In the Kenyan case, where NHIF has offices or desks at the health facilities, the NHIF personnel will collect the data. In any case all the indigent data will have to be entered into an NHIF computer data base as the fund will manage Kenya’s version of Seguro Popular.

Third, the indigents themselves will have to keep proper personal health records, which should be given to community health workers in their neighbourhood for purposes of preventive and holistic healthcare. In this regard, irresponsible and unwarranted visits to health facilities will be minimised as public health officials — or home nurses and clinical officers — will keep vigilance over those under their charge.

It is, therefore, imperative that in the Kenyan case the county governments be brought on board on the management of primary healthcare, including indigent access to Seguro Popular and health facilities.

Fourth, when an individual’s social status changes — and this is quite possible where one gets a steady source of income — she or he will need to report this change immediately and be covered under another scheme with the NHIF. Failure to do so would amount to a criminal offence.

Mexico has had a useful experience with Seguro Social and this experience is worth studying in detail by the NHIF, the Treasury and the National Economic and Social Council. A sense of urgency needs to seize all of us in these matters, and actions taken as of yesterday.

Given that complicated cases like cancer and cardio-vascular problems, for example, have always necessitated expensive and long treatments, how has Mexico approached the problem?

Mexico set up a special medical fund accessible to all Mexicans who are not enrolled in insurance schemes that cover such complications. This is because it is known that private insurance companies usually avoid giving cover to expensive treatment.

Or when they do they make the premium so high that it rules out many people. Cases have been known where insurance firms give up on their patients when they are undergoing treatment due to escalation of costs.

Having said that, time has come when we in the Ministry of Medical Services must have serious discussions with the Medical Practitioners and Dentists Board as well as the Kenya Medical Association regarding cost of healthcare in the private sector. The costs are too high and vary too much from one institution to the other.

Moreover, it would be highly immoral for healthcare costs to go up simply because improvements have occurred in the insurance coverage of the sick. One hopes nothing of the sort happens.

But if there is anything I owe to Kenyans apart from implementing social health insurance, it is to try and persuade our brothers and sisters providing healthcare in the private sector to think seriously about the costs to the patients. Let us this year engage in some discussion that can produce results in the interests of the common good.

The writer is Minister for Medical Services