On April 13, President Uhuru Kenyatta initiated 4.05 billion shillings National Hospital Insurance Fund (NHIF) comprehensive medical cover that would cater for public secondary schools’ students.
The directive given to the Health and Education ministries will see 3 million students get cover and the government will pay 1,350 shillings per student as premium in as part of the greater objective of the provision of affordable health care to all – Big 4 Agenda.
The initiative will run until December 31 and thereafter will be renewed annually from January 1, 2019, for the next five years.
In as much as the plan “will foster a healthy nation as parents will no longer be under financial constraints to cater for medical bills of the students” as the President put it, the idea conjured a stir among the experts who warned that it was a decision lacking foundation.
According to the co-chair of the Universal Health Care 2030 Steering Committee, Dr Githinji Gitahi, the intention was right, and the idea of providing social insurance cover for public students made sense.
“However, there are concerns that social insurance such as NHIF had better focus universal resources and give insurance to the poor who cannot afford care and let those who are well off paying for themselves,” Dr Githinji Pointed out.
He also added that the cover seemed to be a blanket and added that perhaps the government would have made an initiative that will ensure all students joining the public secondary schools have an NHIF card as a requirement then identify children from poor families who need help and pay for their families as part of a social protection scheme.
The same was echoed by the chief executive of Amref Health Africa who noted that the giving a blanket cover is a big risk regarding medical covers for children who are already dependents of their parents cover. Some of the students in these schools may already have coverage under their parents.
Prof Lukoye Atwoli, the dean of Moi University School of Medicine and the honorary secretary of the Kenya Medical Association, said that there was no substantial evidence on how the decision was arrived at. On his part, the government should have ensured that families get insured as it would have more and fruitful impacts. He stated that in a bid to cut on the disastrous health spending, vulnerable groups like children of 5 years and below, pregnant women, and the old should be given a priority.
So, where did the government get it all wrong? For one, a look at the contribution matrix used by the NHIF only predicts a cooking disaster.
The state insurer is currently running on two funding models. Individuals in the formal sector contribute a total of 1,700 shillings through compulsory membership while those in the informal sector and retirees pay 500 shillings in an open and voluntary membership model.
Also, according to the NHIF, members should be above 18 years of age because to register, they must have a national ID. At this age, most students are or have already completed secondary school education.
Let’s face it, a few years ago, the number of students older than 18 could have been higher. But on average, Kenya’s secondary school education usually starts at 14 and runs for four years. Of the 3 million students to receive the cover, how many qualify? Clearly, all secondary school kids cannot be enrolled in the medical coverage and this leaves room for questions.
There are no measures yet to ensure that the money isn’t lost in the pockets of some individuals. Although the president made a promise that the health ministry and the schools would liaise to ensure the process is seamless, the efforts aren’t sufficient.
Many Kenyans, when the plan was first announced was met with criticism even from the public. As it were, some of those in the informal sector are struggling to pay the 500 shillings and are in turn missing out proper health care. The government should have at least given them the priority.
Kenya needs better measures regarding the healthcare system and the medical coverage. Most people in the rural areas have no idea what NHIF is or what it does. As opposed to initiating a plan that might not yield the best results in the long term, sensitizing them, the importance and help all citizens who cannot afford the cover be well placed in their contribution would go a long way in achieving the government’s agenda.
To others, the students’ NHIF plan is just another grand scheme to up the game of corruption in the sector and have the public think it is for their own good.