The latest findings on the status of the National Hospital Insurance Fund (NHIF) are hardly surprising.
A report by the Health Financing Reforms Experts Panel appointed by then-Health Cabinet Secretary Sicily Kariuki presents a damning picture of the fund, stating that it could collapse in two years unless urgent and drastic actions are taken to salvage it.
The NHIF’s problems did not begin yesterday. It has suffered perennially due to mismanagement of funds, corruption and political interference.
Strong cartels comprising private hospitals, fund managers and brokers have, for years, fleeced the institution of the cash painfully contributed by unsuspecting citizens.
In 2018, the Ethics and Anti-Corruption Commission (EACC) conducted an investigation into the health service provision and established that the sector was mired in graft.
Specifically, the EACC singled out the NHIF for censure. The findings, contained in a report on the review of systems, policies, procedures and practices in the pricing for pharmaceutical and non-pharmaceutical supplies in Kenya’s health sector, outlined avenues through which the NHIF lost cash, including inflation of medical bills by private health providers through collusion.
Last year, the EACC published a graft index report that ranked NHIF third in the list of shame, coming after Kenya Power and Kenya Police Service.
Such consistent negative depiction should have jolted everyone into action. But that was not to be.
Indeed, the expert panel’s report reinforces what is in the public domain. But with all the reports, why hasn’t the government taken decisive measures to shake up and clean the organisation? Where is the political will to turn around the fund?
Notably, the report spotlights the NHIF’s operational weaknesses, indicating that its expenditure matrix is negatively skewed.
More than half of its budget, 54 per cent, is spent on administrative costs, mainly staff expenses, travel and accommodation, crowding out cash for the pivotal expenditures — claims settlement.
This expressly demands administrative and structural interventions. The fund’s cost structure has to be reviewed with the objective of cutting the fat and channelling cash to its core business.
To be fair, the NHIF has expanded product offerings to include renal dialysis, kidney transplants, emergency evacuation and foreign treatment, which is quite positive.
But these cannot be implemented when the fund is bleeding. Even so, there are concerns that these benefit those who can afford medical care.
The Health ministry has to institute quick and radical measures to change the NHIF.
It should work with other agencies to rid the fund of corruption, wastefulness and financial mismanagement. With 7.6 million members, the fund can generate sufficient funds.
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