NHIF surgical cover eases pain of costly healthcare for Kenyans

Eunice Wamaitha, a resident of Thika, is relieved that her 9 year old child Victor Wamwea is recovering well after undergoing a surgery to remove a brain tumour at Ladnan Hospital in Nairobi.

This is the second surgery for the child after a similar one at Kenyatta National Hospital in May last year which resulted in temporary relief before the pain persisited forcefully in December.

She had rushed the child to KNH but there were no services due to the doctors’ strike. She then hurried to Coptic Hospital but she couldn’t raise the Sh2 million requested for surgery 

She decided to go to Kijabe Mission Hospital but was told there were no doctors to do the surgery. She was referred to Ladnan Hospital, a private facility with its main centre at Nairobi’s Pangani area, where the boy successfully underwent surgery.

The half a million shilling bill for the surgery was picked by the National Hospital Insurance Fund, where she has been a member since August last year paying Sh500 a month

“I am happy my child’s life was saved. I would never have afforded the surgery without NHIF’s help. I struggled so much to pay for the first surgery. This time I didn’t pay even a cent including for the CT Scans, thanks to NHIF and Ladnan Hospital,” she said as she stroked her child lovingly.

She added: “I hadn’t known the NHIF card could cater for surgery. I came to know only after my child became so sick and I didn’t have any other option financially.”

Eunice is among the growing number of Kenyans who are benefitting from the recent move by NHIF to enhance its health cover from the basic in-patient and outpatient services to include surgeries, dialysis, renal transplant, CT scan, MRI, Chemotherapy, Radiotherapy and Surgery among other crucial services.

Another beneficiary is Peter Chomba, who has been undergoing dialysis at Ladnan Hospital for the last one month. The two dialysis sessions per week would cost Sh15, 000, and a further Sh5000 for drugs and lab tests totaling Sh80,000 a month. But the bill is catered for fully by NHIF just as is the case with nine other patients who undergo dialysis at the facility daily.

His kidney complications begun in 2013, when he was put under medication until this year when the situation deteriorated and he had to begin dialysis.

“Without NHIF, I would not have managed to pay the dialysis costs here. It has really helped me. Since I came here, I have never paid even one shilling from my pocket. I have had the card for 8 years but it only became useful this year after I understood its value,” he said.

Similarly, Virginia Wangui is lucky to have one of her eyes functioning normally after losing sight in one of the eyes due to  Meninigioma, a tumour, usually benign, arising from  meningeal tissue of the brain.

She was diagnosed 8 months ago with the disease in Kenyatta National Hospital but she was put on the waiting list for surgery list like all patients, which sometimes runs to 18 months depending on the department.

Unable to wait, she went to Ladnan Hospital where she successfully underwent surgery in December last year and discharged six days later. The surgery cost almost half a million, but NHIF picked the tab.

Ladnan Hospital's Co-founder and CEO Dr. Abdi Mohamed says most patients often  look behind as they are getting out of the gate when they are discharged, to check if they will be called back to pay the hospital bill.

He said the patients find it unbelievable that they can get advanced care like brain surgery at a private hospital without having to do a harambee or sell their possessions like houses and land. They keep on praying for the hospital and NHIF.

“I am glad that many Kenyans can now access healthcare thanks to NHIF cover.  In a day, we can do between4- 10 surgeries, including advanced ones, for patients with NHIF cards without charging an extra coin. The NHIF enhanced cover is gradually helping to make Universal Health coverage a reality,” he says.

However, apart from public and faith-based facilities, only a few private health facilities are offering services including surgeries, within the price ranges of NHIF without asking the patients to pay extra money. High-end health facilities often ask patients to top up the extra money, which many Kenyans may not afford.

“We agreed to work within NHIF’s figures since our founding mission was to strive  to offer affordable health care to the majority of Kenyans including mama mbogas or boda boda riders who have NHIF cover only, and it gives them surgical benefits up to transplant.” he said.

He added: “The new NHIF benefits have helped decongest the public hospitals and provided access for a lot of patients who would have been unable to afford health services in private hospitals,” he said.

Many other public and private health facilities are not offering the full range of health services covered by NHIF to Kenyans as they are yet to have equipment and facilities such as advanced operating theaters, ICUs and HDUs.

Dr. Abdi said that surgeries, cancer treatment and chronic kidney disease that require dialysis often lead to financial catastrophe and grinding poverty for many Kenyans without health insurance.

He said such high expenditure can mean that people have to cut down on necessities such as food and clothing, or fail to pay for their children's education.

“Many people may decide not to use services, simply because they cannot afford either the direct costs, such as for consultations, medicines and laboratory tests, or the indirect costs, such as for transport and special food. Poor households are likely to sink even further into poverty because of the adverse effects of illness on their earnings and general welfare,” he said.

NHIF CEO Geoffrey Mwangi said they will soon publicize the full list of facilities where NHIF members can access the full-range of services that NHIF covers without being asked to co-pay.

“But even in facilities that ask for co-payment, Kenyans who can pay the extra charge are accessing services at lower costs than before. That is definitely a step in the right direction. But we are concerned that some few facilities are overcharging patients,” he said.

The CEO expressed concern that many Kenyans, especially in the informal sector,  are yet to become NHIF members, largely due to poor awareness about the benefits provided by the social health insurer.

“My appeal to the public is to get NHIF card as the basic minimum cover and fortunately the cover has no age limit or any exclusion criteria. Out of pocket payment for healthcare is unsustainable and can easily lead to a family falling into poverty,” he advised.