National Health Insurance Fund;{NHIF} scandal

Opinion Piece on NHIF Scandal

By Diana Patel

The recent scandal involving NHIF and two private providers of services to the Civil Service Medical Scheme was a predictable event. Whether or not there was corruption involved in the awarding of contracts to various providers, this scenario was inevitable for two reasons.

First, the infrastructure was not in place for services NHIF promised, and second, NHIF was not straightforward about what they could and could not accomplish within their unrealistic budget.

The private sector has been repeating since 2004 that the capacity to introduce National Social Health Insurance to 40 million Kenyans does not exist. The Minister for Medical Services refused to see this as a stumbling block, and the management of NHIF agreed to go along with this delusional view. To bolster their position, NHIF did a “pilot study”, the results and methodology of which they refused to release to the public. Yet they declared it a success.

NHIF’s current problems are for a population of only around 800,000 people, but having already deluded themselves into believing they could manage the 40 million, they thought 800,000 would be a walk in the park.

We in the private health sector did not believe them. Knowing the costs of providing even basic medical care, the capital requirements and mind boggling logistics of setting up the infrastructure required, recruiting and training qualified staff, and putting systems in place to monitor services and supplies, there was clearly no way it could be done. Late last year, NHIF offered to pay Kshs.2,800/= per person per year for unlimited outpatient services to the Civil Service Scheme, including specialists, radiological examinations, laboratory tests, drugs, treatment of chronic conditions, and even family planning. They did offer to involve all providers, not only Clinix and Meridian, but most of us refused, knowing that to genuinely offer those services for that price, we would be bankrupt within a few months. The only way it could be done would be to take the money and forget about providing the services.

NHIF and the Ministry of Medical Services have now been shown to be wrong, and the private sector’s predictions are coming true.

Civil Servants are not getting the services they were promised. When they could not get drugs at the government hospitals to which they were initially assigned, NHIF kindly obliged by telling them they could have choice. Some private providers quickly offered to create more clinics and service points. Neither they nor NHIF wanted to admit that this would take time, or to be honest about what they could

and could not do. To maintain the Big Lie, they had to pay the millions, failing to consider the consequences if the story got out.

And now the story is out.

Interestingly, this has not dampened the NHIF’s enthusiasm to roll out their enhanced scheme for all, and they have proceeded to declare an increase in “contributions” from the employed population. The fact that the unions are against it, that employers are against it, and private health providers are still against it has not changed their view. They are marching ahead oblivious or uncaring about the permanent damage they will do to the health sector and to the lives of Kenyans. We all have our opinions as to why, ranging from campaign fundraising to mere power grabbing, but whatever is the truth of the matter, it is clear that NHIF must be stopped.

It is now time to re-think the Ministry’s Healthcare Financing Strategy. Healthcare for all Kenyans is a great idea, but we are not ready. It will take time, resources, planning hard work, and most of all, honesty. The current approach of denying reality will not do anybody any good, and the consequences of failure will be devastating.

Diana Patel is an economist and the Executive Director of Avenue Healthcare.

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