How Sh2.2 billion was swindled in EduAfya scheme

National Hospital Insurance Fund official engaging school students on Edu- Afya at the Nairobi ASK show 2019. [FILE/Standard] A special audit has exposed the skewed management of funds under the government's Eduafya program. It has further highlighted how ineligible students benefited from the medical cover in the four financial years from 2020 to 2024. The report tabled before a national Assembly watchdog committee also detailed how the government made excessive and suspect remittances amounting to Sh2.2 billion to the defunct NHIF for the period under review. The insurance cover, EduAfya cover, came about after the Ministry of Education and the defunct National Health and Insurance Fund (NHIF) got into a contract for the provision of comprehensive medical cover for secondary school students on March 1, 2018. The initial contract indicated that it was to cover three million insured learners, subject to periodic revisions. Interestingly, the premiums payable for the four financial years between 2020 and 2024 amounted to Sh14.17 billion, but this differed from the actual remittances of Sh16.46 billion made by the ministry. This resulted in an excess remittance of Sh2.29 billion. The report detailed that the excess remittance comprised of Sh821.1 million in the 2020/2021 financial year, Sh25.1 million in the 2021/2022 financial year, Sh867.02 million in the 2022/2023 fiscal year and a further Sh579.7 million in the 2023/2024 financial year. "The excess remittance of Sh2.29 billion between the premium payable and remitted for the period under review was not reconciled or explained," reads the report by Auditor General Nancy Gathungu. It also brought to the fore that out of the 9,312 secondary schools whose capitation was retained and remitted to the Eduafya school scheme, only 8,846 schools had beneficiaries accessing services at the medical facilities over the period under review. For the remainder 466 secondary schools with retained and remitted capitation amount of Sh273.75 billion, there was no evidence of beneficiaries having accessed the medical services. According to the report, there was no data captured in the National Education Management Information System (NEMIS) on the visits to medical facilities by learners from the said schools. The audit also exposed contract violations between the two parties after a review of the NEMIS Eduafya data indicated that there were hospital facility visits by the beneficiaries up to February 28, 2024, despite the contract lapsing on December 31, 2023. During this period, it emerged, there were sixty-five visits with medical services valued at an amount of Sh35,550. Additionally, a review of the expenditure of expenditure returns from NHIF and capitation data in NEMIS revealed that there were 4,100 ineligible students from primary schools and Junior Secondary Schools that benefited from the Eduafya services, yet they were not in the NEMIS capitation data. The beneficiaries accessed medical services valued at Sh40.1 million after having made 15,468 visits to health institutions. "Section 1 of the contract between the Ministry of Education and NHIF define eligible an eligible student for the medical cover as a secondary school student enrolled in a public secondary school within the Republic of Kenya and whose name is stated in a list provided to NHIF by the Ministry of Education...conditions of the contract stated that a member as provided shall be eligible to benefit under this contract and this contract shall only cover such member," adds the report. At the same time, Gathungu questioned the utilisation of the Health insurance retained amount. This was after the report unearthed that an amount of Sh5.39 billion was the total value of visits as per NEMIS, despite the state department remitting an amount of 16.46 billion to NHIF for the period under review. "Therefore, the value for money on the disbursed amount of Sh16.46 billion to NHIF or the health services rendered could not be confirmed," it noted

How Sh2.2 billion was swindled in EduAfya scheme

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