Patients without medical cover strain hospital resources

Matthew Kitoo’s feet were as cracked as his lips. But that only told a fraction of the pain he has been through.

He gazed around with anticipation, his sorry look crying loud for help, contrary to his frail whispering voice.

At 19, and already an adult, orphaned Kitoo has known no joy of being a child. He also has no secondary education because of Hirschprung disease, a congenital condition that started showing when he was three that led to his numerous hospital visits.

Hirshprung, according to Mayoclinic.com, is the absence of nerve cells in the muscles of the large intestines, which occurs at birth and makes it difficult to pass stool. Its symptoms include vomiting and diarrhoea and can be detected 48 hours after a child is born.

For some, like Kitoo it is detected later as the child grows.

In order to manage the condition, a surgery is needed to bypass the affected part of the intestines-creating a colostomy-or remove the part completely. This then may create fistula, where contents of the stomach or intestines leak through the skin, and one will need a colostomy bag always to collect the waste.

In Kitoo’s case, the young man has undergone several surgeries with the last one being mid last year to correct the condition.

 “I have been tormented my whole life. Better part of my large intestines have been removed,” he says, adding that he was forced to drop out of school at grade seven due to his ill health.

Kitoo had his major surgery much later in 2004 at Kenyatta National Hospital where a colostomy, which is an alternative route for passing waste, was created on his abdomen.

He was then forced to cover his abdomen with strapping to avoid stool oozing out and this leaves him with a choking foul smell. Sometimes he uses pampers.

 A general surgeon diagnosis dated July 17, 2018 on consultation, Kitoo had been diagnosed with enterocutaneous fistula and colostomy and was set for ‘review for definitive management.’

He however, had no money, or to the least a National Hospital Insurance Fund(NHIF) card to facilitate any further action: “Even for consultation, I was told to pay Sh600.”

According to an inpatient credit report made in October 13, 2015 by KNH, it is indicated that he has been in and out of hospital for the previous ten years. Being an orphan, the report indicated that, the only dependent he had was his brother who worked as a security guard then.

None of them either is a member of NHIF.

“The patient has been our patient for almost a decade now. He has a colostomy in the right side of his abdomen. He is in and out of hospital until his siblings are now tired of him,” reads the report in part.

And being a secondary school dropout, also means he can’t benefit from NHIF’s free secondary school cover unveiled this year by President Uhuru Kenyatta.

The only resort, he said, was to fund raise for his treatment which saw him camp at Kenyatta National Hospital for the better part of July with a short trip to Nairobi Hospital and back to KNH.

However, without the NHIF card, he could only be assisted at KNH through social welfare. Though he has no phone, last communication with him early this month (August) confirmed that he had been admitted at KNH.

It has been noted by KNH Board Chair David Kimaiyo that up to 78 per cent of patients who visit the country’s largest referral facility have no form of insurance, and such has been a major setback in delivering quality service to Kenyans.

“We do not want to be always crying to the government (for funds). We will have to work with the little we receive from treasury,” said Kimaiyo.

The facility recently launched during the launch of the facility’s Sh18.9 billion 2018-2023 strategic plan. Included in the plan is a proposal to increase fees charged to patients in a bid to stabilise its income.

Similarly, the hospital will be setting up a 300 bed capacity private wing facility as part of its plan to generate more revenue occasioned by financially unstable patients at a cost of Sh3 billion.

As documented Health Sector Performance Review report for 2016/17, the 300 bed hospital will be a subsidiary to KNH and will be run on private business principals.

“The objective is to attract clients who are able to pay to generate revenue to support those who are not able to pay for health services at the main hospital,” the report read in part.

These are just some of the contingency plans KNH has to cushion itself against uninsured patients.

During a probe by the National Assembly Health Committee when KNH was marred with claims of mismanagement and malpractice, the suspended Chief Executive Officer Lily Koros said KNH lost up to Sh658 million in 2017 after the facility was forced to discharge patients who could not afford to pay and had no NHIF.

While the bed’s capacity is about 2,000 it is sometimes forced to handle up to 4,000, majority being patients from poor homes.

A big chunk of these patients, as documented in the parliament report, are accident victims and expectant mothers.

According to the March 2018 report, the bed capacity of maternity ward was said to have a bed capacity of 50 but found to be holding 132 babies. The hospital also handles between 1,200 and 2,000 babies per month.

But since some of these mothers have not subscribed to any of NHIF maternal packages-maternity covers and Linda Mama-they are forced to stay longer in the hospital as their families solicited for cash.

“This has stretched out and strained human resource at the facility since they are mainly referrals,” the report reads.

In order to benefit from NHIF maternity package, one needs to contribute just Sh500 per month as part of the normal cover. However, NHIF’s Linda Mama programme caters for mothers who are not necessarily NHIF members and all they need is to register with the nearest accredited facility in their locality.

For terminally ill patients like Kitoo, NHIF has revealed of plans to invest into preventive care in order to manage such cases once one subscribes to the cover, which will ease the strain in hospitals and also not dent patients’ pockets, but at the same time save lives.

NHIF Manager in charge of Programs and Scheme Fardosa Abdi said the proposed plan is already before the Ministry of Health and will have an integrated wellness family health benefit package.

“It will entail annual medical examination for all NHIF members with their dependents. The benefits include cancer screening, immunization, deworming, health studies and other benefits,” said Abdi.

Current numbers by NHIF indicate that at least 25 million Kenyans are covered courtesy of 7.6 million principal subscribers.

By 2022, NHIF targets to have at least 19 million subscribers so as to ensure that all the over 40 million Kenyans have some form of basic insurance.

To achieve this, NHIF is now targeting saccos (like transport saccos) and farmers’ cooperatives in the informal sectors.