Health insurance has become an integral part of Kenyans with more enrolling with the national public health insurer – NHIF.
With increased coverage and more health facilities being enrolled under specific contracts depending on what they offer, cases of fraud which the fund has fought vigorously over the past few months are bound to arise.
In July, a case involving use of a card fraudulently in Isinya, Kajiado grabbed headlines and the matter was taken to court. NHIF CEO, Geoffrey Mwangi, said that the fund had put in place measures to ensure that such incidences are prevented.
Kisumu is no exception; however a different approach is being taken to handle any case that may arise.
Kennedy Odhiambo, NHIF’s Kisumu branch manager, reveals that some facilities have been tempted to get involved in fraud and have been held to account.
He recalls one facility which claimed funds for a major surgery yet it has no theatre while another was found to have increased the number of days for patients.
“The second case raised questions when they brought claims for patients and we found that some of these patients had malaria which would not warrant a patient to stay in hospital for eight days,” says Odhiambo.
He says that some even claim for services that have not been offered. When these are found, the contracts are cancelled as investigations are undertaken.
One of the most common cases which Odhiambo says is mainly solved through public education is use of other people’s cards without knowing that it is an offence.
“You might find some of these people just take a card belonging to a relative and they want to use it; in such a scenario, the nest way is to educate them on the importance of registering and who is eligible to use a card or treatment,” says Odhiambo.
Despite all these, Mwangi says that increased surveillance has been put in place. And Odhiambo adds that NHIF officers conduct undercover operations which have now deterred facilities that may be tempted to engage in mischief.
Just like Nairobi, Kisumu has witnessed increased enrolment. Regarded as the third largest city in Kenya, Kisumu’s population has been bulging over the past few years.
According to the Kenya National Bureau of Statistics (KNBS) 2009 national census, the population of Kisumu County was 968,879 but almost ten years later, it is expected to have doubled.
With this comes the need for healthcare or the public. Kisumu has a total of 168 health facilities that have been contracted by NHIF to offer services to the people.
According to Mwangi, the fund has in the past one year gone into a relentless recruitment campaign seeking to tap into the 12 million Kenyans that are in the informal sector.
In Kisumu, for instance, while the target to add more members from the public formal employment sector to the fund was 1,000 in the last financial year, the records show that it managed to recruit 1,305 thus surpassing the target.
Coupled with this, the Kisumu branch manager Kennedy Odhiambo pointed out that the county managed to recruit 10,626 members from the informal sector.
“One of the reasons why we managed to increase the number was due to involvement of NHIF in critical cash transfer programmes that are being undertaken by the government, targeting the vulnerable in society,” said Odhiambo.
But these have not come without challenges, as Odhiambo points out.
While the enrolment of those in the informal sector is a great achievement, the greatest challenge is in retention.
Odhiambo says, “Some join but since they do not fall sick, end up thinking that contributing to the fund is a waste of time and end up dropping until they fall sick and remember that they were once members of NHIF.”
He also alludes to the reality that some members just join the fund when they are already sick and realize that the fund has enhanced comprehensive packages.
Some of the packages that fund offers now include cancer treatment services, surgical operations, kidney dialysis and maternity care.
One of the programmes that has seen membership surge is the Linda Mama programme which is basically free maternity care where women register when they are pregnant and deliver free of charge in public and mission health facilities.
With registration based on the mobile phone, it makes it easier for women to enroll and enjoy the benefits of free maternity as envisaged in government policy.