#FRONTROW: Does NHIF really know how insurance works?

Wednesday November 8 2017

Patients in a ward at the Kenyatta National

Patients in a ward at the Kenyatta National Hospital. The state-run National Hospital Insurance fund had essentially changed the fund to an inpatient service, to the disadvantage of those whose illnesses are serious but do not require admission. PHOTO| FILE| NATION MEDIA GROUP 

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It’s right there in its name: National Hospital Insurance Fund but I don’t think anybody at NHIF actually knows what that means. This is surprising, considering that this is a state corporation that has been around since 1966.

Heck, they have a whole Act of Parliament that governs them now and it has been in place since 1998.

It seems to do better in the scandal department than in what should be its core role: providing “accessible, affordable, sustainable and quality health insurance” for all Kenyans older than 18, and whose monthly income exceeds Sh1,000.

If they were familiar with these building blocks of what they’re supposed to do, they would not have come up with their objectively horrible new regulations last week.

Just days after it was named the Best Insurer in Africa by the International Social Security Association in Addis Ababa, Ethiopia, some top managers had what they considered a brainwave.

Members would now be limited to four hospital visits a year for outpatient services, and each would need to cost no more than Sh1,500.

What NHIF was essentially telling everyone was that they needed to plan their sicknesses for the year in advance and make sure it is nothing serious that would be too expensive.

Even if you pay the maximum contribution of Sh1,700 per month, which comes to Sh20,400 every year, the fund would only cover you for up to Sh6,000.

So the extra 14,600 you had paid in that calendar year was just charity because you’re a kind human being and are really into state agencies taking your hard-earned money and throwing it away.

I remembered my high school commerce lessons during which Mr Gordon Amuok repeatedly told us that insurance worked on the principle of pooling of risks. I’m no expert, obviously, I’m just a silly journalist, but it seemed to me that NHIF had just redefined what insurance means.

“Capping has to be there to ensure sustainability as it helps in reducing wastage or unnecessary visits. Limits are pegged to the contributions made,” CEO Geoffrey Mwangi said and I couldn’t roll my eyes far back enough.

Who goes to the hospital for an unnecessary visit just because they feel like it?


The worst part is when Mwangi then tries to pass this off as a good thing.

“This is an improvement to give our members more freedom, ease and more importantly, portability of their benefit packages.”

Those are English words  arranged together to form a sentence but they mean nothing. Does this man even know why we, the hard-working but long-suffering taxpayers of this republic, pay him tonnes of money?

He had half a dozen health providers surrounding him at the press conference and they all gave glowing reviews of the new changes while Mwangi smiled indulgently and nodded along in agreement.

They had essentially changed the fund to an inpatient service only while still somehow trying to convince themselves that this was an upgrade of what they have done before.

Instead of availing healthcare to the masses at a price they can afford, they had done the exact the opposite by denying them that chance.

The poorest people in Kenya are the ones that depend on NHIF the most.

They are the ones who cannot afford the overpriced private insurance providers and rely solely on the state-run programme to pay for treatment when they fall ill.

Like you, they don’t know when they will come down with malaria or cholera or whatever is in the air these days. They do not know how much the hospital will charge when that time comes but it is almost certainly more than Sh1,500.

Heck, consultation fees alone at most hospitals are significantly higher than that. In the four months to October, NHIF had paid Sh5.9 billion in members’ medical bills and most of that went to surgeries.

That is no reason to disadvantage those whose ailments do not lead to admission but are no less serious. I’m not a doctor but I know what happens when you are sick and you do not get treated: you die.

The good folks who work at NHIF need to learn that they are there to make sure people don’t die.

If they understood that, it wouldn’t take the Health Cabinet Secretary Dr Cleopha Mailu to suspend ill-thought-out regulations like he did with this one.

In an announcement billed as the end of co-paying and eliminating the need to pre-select health facilities, the biggest headline was the four visits cap.

I have been dutifully paying my NHIF contribution for more than a decade and I have never once used my card to pay for treatment. I don’t complain because I know it props up our broken healthcare system.

There are many like me who subsidise treatment for others.

You had one job, NHIF, and you failed at it. Sad!


Is he right? Send your comments to Larry Madowo at [email protected]




THE IPHONE X (pronounced “ten”) came out on Friday and my cousin, Charles Madowo, sent me a picture of several dozen people waiting in line hours before Apple stores opened in New York.

Sitting there in their warm clothes and little tents, they were spending the night in the cold just to be the first to give the California-based company upwards of $1,000 (Sh103,000) for a shiny new phone with a giant screen and made of glass that shatters both at the front and the back.

You can unlock it by just looking at it and has these things called animojis that allow you to take ordinary emojis and make them mimic your actual facial expressions.

The camera has one or two nifty tricks added and the whole thing has a pretty Apple logo thrown at the back. For all those gimmicks, the price costs more than most laptops and almost every other phone on the market. Is Sh100,000 too much to spend on a phone?

Sure, it is a status symbol and I can’t wait to get my hands on one but this is probably where our consumerism culture gone mad has truly fallen apart.

But there are many sheep out there who don’t care for the overpriced phone and always respond the same way: shut up and take my money!




There was a time when Sally Kosgei was one of the most powerful people in Kenya.

Just before she became Head of Public Service in 2001, she is alleged to have bought a high-end apartment in London near the Harrods department store using a Mauritian company previously registered in the Isle of Man. This new revelation is contained in the “Offshore Leaks Database” by the International Consortium for Investigative Journalists (ICIJ).

The former Aldai MP told ICIJ that she bought the flat with personal funds, and  that she had “satisfied all obligations (legal, professional and ethical) as a public official in Kenya.”

She says that was before she took up the Public Service job and it was because her children were in school in the British capital.

ICIJ was quick to add a disclaimer: “We do not intend to suggest or imply that any people, companies or other entities included in the ICIJ “Offshore Leaks Database” have broken the law or otherwise acted improperly.”