Why NHIF is central to delivery of universal healthcare

Thursday, February 20th, 2020 00:00 |
National Hospital Insurance Fund headquarters on Ngong Road, Nairobi. Photo/PD/FILE

By Sandra Ochola

Attaining Universal Health Coverage (UHC) remains a goal for many developing countries. Those that have managed to achieve this feat are offering their citizens quality medical services as a result of collective public good will and the establishment of sustainable financial management systems. 

The idea is to make healthcare accessible and affordable to all. That citizens should not pay more than they should and that every person should enjoy their right to the highest attainable healthcare standards. 

Almost two years ago, the government rolled out the UHC pilot programme in Machakos, Isiolo, Kisumu and Nyeri counties.

These counties have provided insights into what our national UHC programme will look like.

When fully operational, our community healthcare structures will ensure we are saving on time and resources through a sustainable referral system.

The shelves in pharmacies will be full of drugs, hospitals will be equipped and specialist doctors and nurses will be available in every medical facility. 

Most impressive is that citizens will pay less to access health care services. The National Hospital Insurance Fund (NHIF) has, to a large extent, eased this pressure.

This is especially true for those subscribed to the benefit packages allowing them to access quality medical services. In fact, NHIF is positioning itself as a key player in the attainment of UHC, a goal that when achieved will necessitate the seamless delivery of healthcare services to the citizenry. 

To get there, however, a number of managerial and operational changes have to be undertaken. In a recent press release, the NHIF Board highlighted a myriad of reforms it is undertaking towards this goal. For instance, it is in the process of addressing corruption cases that have tarnished the Fund’s image. 

It has been unearthed that there are hospitals, employers, NHIF staff and suppliers who have colluded to corrupt the Fund’s systems. The identified hospitals have, for example, been inflating medical costs and even those of medical equipment to make a quick buck. Patients have oftentimes been billed for services they did not enjoy. 

While the implicated hospitals have been suspended, the rogue staff convicted and files forwarded to the DCI, there remains the challenge of sustaining the fund without adequate resourcing. The Abuja Declaration of 2001 demands that it signatories allocate 15 per cent of its budget to healthcare. We are yet to achieve this milestone. 

Consequently, it is necessary that we effectively manage what we have amid the country’s competing priorities. 

NHIF is in the process of incorporating ICT into its operations to enable strategic purchase of UHC benefits package. It is also establishing Primary Care Networks to align to the existing UHC deliverables at the community level. 

Most attractive is that the fund is looking into ways of reducing its administrative costs and further cutting costs in advertisement, travel and accommodation and bank charges and commissions. 

Even then, citizens still complain of inadequate benefits packages with complicated access and authorisation processes. For them, no two hospitals offer the same service under the NHIF making the process uncertain and expensive. Some of the proposed reforms towards this include that service providers will moving forward, be authorised by the Ministry of Health. 

The authorisation will also take into account the views and recommendations from established bodies such as the Kenya Medical Practitioners and Dentists Council and the Kenya Health Professionals Oversight Authority. 

Further, the Fund has established a centralised online pre-authorisation platform based at its headquarters. Moving forward, hospitals must be able to provide exactly what they claim to provide and in the right quality and qualities. 

Of equal importance is the need to rethink the regulatory structures pertaining to private medical insurance service providers. NHIF has identified its strengths and challenges in pursuit of UHC. 

As a complimentary facet to our healthcare system, it is necessary that the private sector undertake the same audit if we are to holistically address the challenges of fraud, abuse and wastage that are impacting of citizens’ right to quality healthcare. 

—The writer is an Advocate of the High Court

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