NHIF lacks capacity to safeguard members’ funds entrusted to it

The launch of the Sh4 billion NHIF Medical scheme for 3 million secondary school students came a day after I expressed my reservations about the same. A revolutionary concept in its own right, the rationale behind it is superb. That it falls in the ambit of one of President Uhuru Kenyatta’s Big Four Agenda and his desire to leave an enduring legacy simply means the president is sincere in his quest. Whether it succeeds or not is a different matter altogether.

This scheme targets to enroll secondary school students for medical cover in hospitals close to their institutions. The story will be quite different for students in the arid and semi-arid areas, where hospitals are a rarity. Documentaries have shown volunteer nurses hanging drips on tree branches while the patients contend with sleeping on the hard, dusty ground. There was the story of a volunteer assistant chief taking care of his people by doubling up as a nurse, and the only available medication was generic paracetamol. It is anybody’s guess how the new scheme will benefit students in these forgotten areas.

Cases abound in which students have died in school only for their parents to be called to collect corpses. A handful of schools employ nurse maids, but their scope is limited. Any parent who has had a child in secondary school will attest to the fact that sick students are merely given pain killers. Parents get informed of their children’s sickness when it gets worse, and sometimes too late. Because this new scheme will take such worries away from parents by guaranteeing timely treatment or management for, among other diseases, cancer, HIV/Aids and the provision of prostheses for those who may suffer amputations at the insurers cost, it is welcome.

Double registration

In the current scheme of things, children, below 18 years, are covered by their parents’ National Hospital Insurance Fund covers. Most, if not all secondary school students, finish form four when they are 18 years.

I visualize a situation where once the registration of students is done, the computer will flag cases of double entries, because all benefactors’ data is captured and stored in the NHIF’s central data bank. It is here that the mischief I earlier alluded to could arise. Another area of concern is the submission of claims by contracted hospitals. NHIF accredited hospitals exceed 2,000. In the months of July to October last year, NHIF paid Sh5.9 billion in medical bills. In the same year, NHIF hired detectives to investigate monthly losses of Sh500 million through fraudulent claims. Of course, the shocking allegations of fraud involving Clinix Healthcare limited and the Meridian Medical Group that surfaced in 2012 come to mind. Collectively, there were questionable deals amounting to Sh4.2 billion.

When hospitals individually submit their claims, that tends to create a maze through which funds could easily be lost. Wading through all that paperwork can be daunting, and that is the reason why stringent controls should be in place. Parliamentary probes after a theft are perfunctory, for never once has Parliament pinned down culprits; not when the Parliamentary Accounts Committee also once came under the spotlight for indulgence in corruption.

Unchecked fraud demonstrates that NHIF has no capacity to safeguard members’ funds. Entrusting more to it is therefore injudicious. In a way, this makes the need to contract an independent company with the wherewithal to manage e-payments apparent. Doing so would leave enough time for NHIF managers to concentrate on administrative issues and come up with competitive and viable policies.

Smart card

A centralised e-payment system may be the answer to the corruption that has so often derailed the best of intentions. Accountability is key to the success of NHIF, whose membership exceeds 6.5 million.

NHIF’s smart card has not stopped fraud, yet there are plans to curb fraudulent claims through fresh biometric registration that captures finger prints and the photos of beneficiaries. However, the efficacy of the new scheme cannot be guaranteed. The current set up in which each Government institution comes up with its own smart card is susceptible to manipulation.

Why does one need separate cards for NHIF, Driving License, National ID and NSSF, yet the information they contain is the same? To put this in perspective, imagine a situation where one employee is given separate computers for Excel, PowerPoint, Outlook and Word. At best, this is a waste of money and space. An integrated smart card could go a long way in solving many of the challenges Government institutions face.

The unfortunate incident in which top-notch doctors failed to save the life of a woman stabbed on the thigh, but proceeded to charge her kin more than Sh800,000 for their dismal showing, is the best argument for improving healthcare in the country.

Mr Chagema is a correspondent at The Standard. [email protected]