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The Sh4.2 billion medical scheme for civil servants will now be managed by a private administrator after workers' complaints of poor service delivery from the national health insurer.
One of the recommendations from a technical committee set up by the Ministry of Public Service proposed to have the National Hospital Insurance Fund (NHIF) relinquish key roles in the scheme and appoint an administrator to take charge.
These are the areas where NHIF has fallen short in the multi-billion medical scheme that serves more than 130,000 civil servants.
Principal Administrative Secretary in the Ministry of Public Service Mary Kimonye has already forwarded the set recommendations to be adopted by NHIF.
“The purpose of this letter is to forward the report for implementation of the recommendations with a view of improving service delivery and the level of satisfaction of scheme members,” reads the letter addressed to NHIF acting Chief Executive Officer Nicodemus Odongo.
Outpatient services
The recommendations touch on outpatient services, emergency services, referrals and handling of complaints raised by civil servants and their dependents.
In the letter, NHIF is expected to contract only networked public and private healthcare facilities to provide both outpatient services at both county and national level.
The national insurer should also develop and implement a clear referral policy to be used by the Government workers as well as a complaints handling mechanism.
“NHIF to contract a scheme administrator to undertake automated registration of members and dependents, relay real time communication to service providers (hospitals),” reads the letter in part.
In February, civil servants through the Union of Kenya Civil Servants initiated the process of seeking to oust NHIF from managing their Comprehensive Medical Insurance Scheme for Civil Servants.
The union claimed members were still subjected to hospitals with no drugs, equipment, and their dependents turned away especially at night.
A Government report noted that civil servants are now being forced to pay out of pocket for medical procedures and services that are covered under the scheme.
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