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NHIF should put its house in order, be more accountable

By Gabriel Dolan | November 17th 2019

The Catholic bishops' reservations about the recently concluded International Conference on Population Development (ICPD25) grabbed the headlines. Holy Family Basilica also played host to a parallel event organised by Christian professionals who earlier handed over a petition signed by 87,000 requesting the President to cancel the UN sponsored event. 

However, amidst the hullaballoo, most media houses gave scanty coverage to the Prelates’ statement on grave concerns associated with the performance of the National Health Insurance Fund (NHIF). Yet the two matters are intricately linked as without access to affordable, professional health services we cannot speak of reducing infant mortality, FGM or teenage pregnancies. 

The religious leaders raised an alarm bell when they revealed that the NHIF owes church based medical units Sh1.9 billion in unpaid bills since September 2018. That is a huge figure covering the hundred or so church facilities registered with NHIF. Since most of these run on a very low budget, failure to pay promptly will mean that medical supplies may not be purchased and staff remain unpaid. In effect, services may grind to a halt. There has been no public response to date from NHIF CEO Nicodemus Odongo.

The church of course is not the first to raise disquiet over the much lauded NHIF and the state of Universal Health Coverage (UHC) that falls under the Jubilee Big 4 Agenda. In December last year, the then CEO Geoffrey Mwangi was arrested and charged in court over the questionable single sourcing of an integrated revenue management system. The cost to the taxpayer for that system was Sh1.4 billion while the market price is less than half that price. 

Just last month, the Parliamentary Committee on Health questioned the current CEO on payments made by NHIF for treatment abroad. They revealed that during the period 2018/19 a whooping Sh17 billion was paid by NHIF for medical services abroad. The MPs argued that the poor were subsidising treatment for the rich a point that was disputed by the NHIF management. Yet, when the conditions for accessing treatment outside the country are not freely available, the poor are at a severe disadvantage when it comes to health care protection. 

I have not heard of any working class member travelling abroad for treatment under the NHIF scheme. It behoves NHIF then to open their records and reveal who have benefited from treatment outside the country. The MPs also revealed that during the same period Sh22 billion was paid to private hospitals and a mere Sh7 billion to public hospitals. That is another disturbing statistic. 

The revamped NHIF definitely has achieved a lot in a short period of time, verified by experiences shared by beneficiaries. Yet, despite the progress made there are still only 8.5 million Kenyans registered as members. The informal sector can register and make their payments of Sh500 per month while the formally employed pay between Sh500 and Sh1,700 per month. Yet, according to a World Bank report only 3 per cent of the very poor are registered. That is a far cry from the commitment of Jubilee to provide universal health coverage. Indeed, many employed people are already covered by their own private or employer health insurance. 

NHIF collected Sh47.8 billion in contributions in 2017/18. Thirty three billion was collected under the national scheme while the balance was remitted under the premium scheme designed for civil servants. It would be interesting then to show what percentage of the contributions goes to the public or are those on the premium scheme getting a disproportionate share as the ones who are benefiting from treatment abroad at the expense of the common worker. In other words, are the working people paying for premium treatment for government workers? 

This is not an accusation but a valid question that everyone has a right to ask. There is a lot of goodwill towards NHIF but that feel-good factor should not be exploited. There must be more open public disclosures about their audited accounts and more accessible information to the public on the entitlements and services available to members. Thirty years ago the NSSF scheme fell apart through mismanagement, fraud, and political interference. This must not be allowed to happen with NHIF as the health and hopes of millions of Kenyans are at stake.

- Gabriel Dolan [email protected] @GabrielDolan1

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