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The concerns have been raised because the NHIF is using a capitation method/FILE


Worries of graft in new NHIF scheme

The concerns have been raised because the NHIF is using a capitation method/FILE

NAIROBI, Kenya, Apr 10 – Kenyans could be staring at yet another mega scandal as reports emerge that the National Hospital Insurance Fund (NHIF) has accredited non-existent and non-functional health facilities to offer services to civil servants under their newly established health scheme.

According to the Kenya Medical Practitioners Pharmacists and Dentists Union (KMPDU), the outpatient health facilities in question do not have a countrywide reach as they claim.

The concerns have been raised because the NHIF is using a capitation method to pay accredited hospitals for outpatient services. Two outpatient facilities have been cited among the accredited health facilities.

The NHIF says each accredited facility is receiving Sh2,850 for every principal member per year for outpatient care. This is then multiplied by five dependants which translates to Sh14,250 per year for a principal member and dependants.

This amount is disbursed after every three months, translating to Sh712 for every principal member.

NHIF has confirmed that one of the clinics was allocated to serve 56,000 principal members in its purported countrywide clinics. This adds up to about 280,000 principal members and their dependants.

Based on this calculation, the amount paid out to this particular outpatient clinic on March 26, 2012 for the first quarter by the National Hospital Insurance Fund was Sh199,360,000.

The second facility in question on the other hand, was allocated to serve 38,000 principal members. Following the same calculation, they were on the same day as the first questionable facility paid Sh135,280,000 by NHIF.

The doctors’ union singles out Kapsabet, Webuye, Eldoret , Bureti, Iten , Kericho, Kabarnet, Kakamega, Mumias, Kimilili, Nyandarua, Mwea, Karatina, Busia, Bungoma, Maua, Narok, Kitui, Machakos, Kinamba, Nkubu, Embu, Muranga, Nyeri, Kiambu, Mpeketoni and Malindi as having ghost or non-functional clinics.

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The Kenya Medical Practitioners and Dentists Board (KMPDB) is charged with registering medical institutions – both private and faith based.

In a letter dated January 20, the medical board had raised concern that one of the institutions in question was operating unlicensed facilities.

“Kindly note that information received in this office indicates that you are using letters of acknowledgement of applications as a license to operate some of your unlicensed facilities. Kindly stop that practice,” the letter from KMPDB Chief Executive Officer Daniel Yumbya stated in part.

It further advised that all the concerned facilities must be inspected by the respective Medical Officers of Health and a report submitted to the board. It also directed that the names and copies of professional certificates for doctors or clinical officers in charge must accompany the inspection report.

“When I did the letter it was very clear. That was the information we had but I must admit that things may have changed… there may be other additional facilities that have been registered after that but not all of them. But I cannot give you specifics because we may be accused of giving information to the media,” Yumbya said in an interview with Capital FM News.

A number of unregistered and unlicensed health facilities whose applications were still pending because they had not fulfilled all the board requirements as at January 20 this year included some in Pangani, Imara Daima and Ngong Road.

In Coast region, there are unregistered clinics in Malindi, Ukunda, Kilifi, Voi, Kongowea, Lamu and Kwale.

In the Rift Valley, questions linger over facilities in Nanyuki, Kitale, Kapenguria, Molo, Naivasha, Kabarnet, Kajiado, Kericho, Bomet, Eldoret, Narok, Iten, Moi’s Bridge, Bureti, Samburu, Marakwet, West Pokot, Turkana and Transmara.

According to the NHIF Website, accreditation of a health provider takes into account the services, personnel, infrastructure and equipments.

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The fund further contracts the health facilities to ensure they provide services comprehensively. This means that NHIF members walk in and out of the accredited facilities fully treated at the cost of NHIF without making additional payments.

The NHIF accreditation assessment manual includes name of institution, province, district, licensing by MPDB and DMS to operate, type/category- GOK, mission, private, community, when the hospital started, bed capacity, number of full time staff, nearest NHIF office.

But the Union of Kenya Civil Servants which entered into an agreement with the NHIF and Ministry of Public Service for its members to forfeit their monthly medical allowances and instead be enrolled in the new medical scheme is equally disappointed.

In an interview with Capital FM News, Secretary General Tom Odege said the scheme which became operational in January was prone to corruption due to the capitation method being used for outpatient care.

“Capitation is a very easy way of breeding corruption in a soft way,” he said.

Odege said although the idea of providing medical insurance to civil servants was noble there were a number of concerns that must be addressed.

First, he said, was the challenge of ghost outpatient facilities.

“They are in major towns but when you go to the initial records released (to Civil Servants), we were told they are all over the country. But in reality they are not. In some counties like even in my county Migori, they are not there,” Odege said.

He noted that the problem emanated from some facilities trying to grab the opportunity when they were not well established.

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“There are these people trying to portray as if they have clinics all over the country and this is a wider scheme to corrupt the system whereby you will find a group of hospitals or doctors are colluding with the group in NHIF and those ones have to be blocked out if we are to make the system efficient,” he said in the Interview.

Another issue Odege raised was lack of drugs in government facilities and members were being forced to buy drugs from chemists without reimbursement.

“People have been made to believe that when you buy drugs outside the scheme you are allowed to make a claim and the claims are not going back so this one is also a challenge on the NHIF side,” he said.

The civil servants were also being charged a ‘gatekeepers’ fee for their records to be accessed. Odege said government hospitals were charging Sh100 while Private hospitals charged Sh200.

“It’s not clear after how long are you supposed to go to hospital and pay that money. If it is per visit it is even more expensive than the money which we used to get in medical allowance. So if there is no clarity on whether this money should be paid once a month or once in a lifetime, again it will come out to be expensive to the workers as some hospitals are charging per visit,” he complained.

The concerns on how the scheme is being handled is now before Parliament’s departmental committee on Health and the entire board of NHIF is expected to appear before the committee on Wednesday to explain the accreditation process of health facilities.

They are also required to provide the parliamentary committee with records of financial transactions between the fund and healthcare providers under the new civil servants and teacher’s schemes.

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