Caution Needed With the Government Health Plan

Lukoye Atwoli

Sunday Nation 15 January 2012

The government recently announced a new health plan for civil servants encompassing outpatient and inpatient care as well as payments for disability and death. There has been scanty information on the administration of the scheme, but it seems clear that it would be administered largely by the National Hospital Insurance Fund (NHIF).

On the face of it, this deal is good for civil servants, as it offers them something they have needed for many years. The workforce in Kenya remains largely poor and unhealthy, compromising the quality of work in the civil service and creating a vicious cycle that ensures that majority of Kenyans remain mired in poverty with no hope for a respite.

This deal has the potential of alleviating this problem and improving the health of Kenyan workers.
Improved health care will obviously have a huge impact on the economy and should see us getting closer to achieving our national goals and vision.

The problem arises when one attempts to interrogate the implementation of this plan.

NHIF indicated that civil servants would be able to get care at all public and mission facilities and some private hospitals that will be accredited for this purpose. Indeed, workers were advised to nominate three facilities they would be seeking care at under the plan.

After the announcement that the plan was operational from the beginning of the year, some disturbing issues have been noted by concerned civil servants. NHIF has allocated every civil servant to particular health facilities, both public and private.

Under the plan, NHIF has identified some private "providers" to provide care for civil servants.
In an ideal situation, one would have expected NHIF to sign contracts with the individual hospitals to offer care to the covered members, but instead they have contracted what are effectively middlemen to administer the plan in some areas.

Two of the contracted private providers do not have sufficient facilities of their own, and it is clear that they will only serve as middlemen in the process. Some of the "clinics" identified on their websites are actually non-existent, and it is even doubtful if they have enough workers to offer quality health care to members of Kenya's civil service.

There are two major problems with this arrangement.

Firstly, there have been queries raised in the past over NHIF's ability to manage the funds they currently collect for outpatient cover. One wonders what has changed since an audit revealed that a huge proportion of funds collected by NHIF is used for administrative purposes, and not the core business of providing health insurance.

Secondly, the details of the scheme remain hidden, even to the beneficiaries themselves.
Many civil servants currently do not know anything about it except what has been covered in the media.
Is this the way to implement a medical scheme? Where are the individual contracts for the civil servants, containing the extent and limits of their cover?

For instance, where will they be treated when they get sick away from their stations?
In my view, services at our public facilities need to be improved to enable all public servants to have access to care anywhere in the country.

NHIF should then have no problems providing cover for these individuals, and no public servant should ever have to seek care in a private facility.

Dr Lukoye Atwoli s secretary, Kenya Psychiatric Association and lecturer at Moi University's school of medicine.