Experts fault NHIF students’ cover as lacking foundation

President Uhuru Kenyatta (back right), Deputy President William Ruto, Cabinet Secretaries Sicily Kariuki (Health, front left) and Amina Mohamed (Education) look on as Education Principal Secretary Belio Kipsang, flanked by NHIF chief executive officer Geoffrey Mwangi, signs the contract that saw the implementation of the medical cover scheme for secondary school students, at State House, Nairobi, on April 13, 2018. PHOTO | SAMWEL MIRING'U

What you need to know:

  • The scheme targets to cover all students in public secondary schools for treatment of all kinds of injuries and diseases.
  • Prof Atwoli said the government should have instead focused on ensuring that families are covered as it has more impact compared to covering adolescents.

A directive by President Uhuru Kenyatta for the ministries of Health and Education to enrol three million secondary school students into the National Hospital Insurance Fund (NHIF) programme launched over the weekend is still questionable.

President Kenyatta’s initiative was first announced last year and was expected to kick off in January, but experienced some delays.

This directive however has been questioned based on the current contribution matrix used by the state insurer.

Currently, NHIF runs on two funding models where those in the formal sector contribute Sh1,700 through compulsory membership while those in the informal sector and retirees pay Sh500 in an open and voluntary membership model.

TREATMENT
As it is, principal members of the Fund can only be above the age of 18 because the insurer requires a national identity card during registration.

This therefore means that secondary school children cannot individually be enrolled to NHIF as most are still below this age and are therefore covered under a principal contributor as dependants.

But the Sh4 billion grand health scheme launched last week for secondary school students targets to cover all students in public secondary schools for treatment of all kinds of injuries and diseases, including cancer and HIV/Aids.

Students who lose limbs while in school or during educational activities will also be entitled to prosthetic replacements at the insurer’s cost.

The NHIF cover will also take care of the surgery costs, cover air and land ambulance services and will qualify students for reimbursement of costs incurred for treatment abroad.

POVERTY

But despite the glossy comprehensive cover signed between the two ministries and the NHIF, health experts feel the government got it wrong.

Dr Githinji Gitahi, the co-chair of the Universal Health Care 2030 Steering Committee, said whereas the government’s intention is right to provide social insurance cover for students, there are concerns that social insurance such as NHIF should focus public resources to only cover those who cannot afford care and let those who can afford pay for themselves.

"This is not the case for this cover as it seems to be blanket.

"It would be better to ask every student for an NHIF card as a condition to admission to school and then identify the poor kids and pay for their families as part of a social protection scheme.

"Many of these kids may already have cover under their parents," Dr Gitahi said.

REQUIREMENT

According to the Amref Health Africa chief executive officer, the best approach would have been to make NHIF membership a mandatory requirement just like a birth certificate for joining secondary school and find a mechanism of identifying those who cannot afford and are not covered under their parents and pay for them.

"The president has advisers and I respect that. And we are most appreciative of the move to provide universal health coverage.

"However, by giving a blanket cover, we risk covering children who are already dependents of their parents cover," he added.

According to Prof Lukoye Atwoli, the honorary secretary of the Kenya Medical Association, the government should have instead focused on ensuring that families are covered as it has more impact compared to covering adolescents who are not the largest consumers of health services.

"We have not been provided with sufficient information on how this decision was arrived at, because if someone was to reduce catastrophic health expenditure, they should focus on vulnerable group[s] like pregnant women, children under the age of five, the elderly et cetera," Prof Atwoli, who is also the Moi University School of Medicine dean, said.

COLLABORATION
However, NHIF chief executive officer Geoffrey Mwangi sought to allay fears saying the scheme is water tight and all players should pull together to make it a success.

"This is an enhanced cover. It is a bit different from the national one, therefore the issue of double payment does not arise.

"The students have previously been covered through a capitation method where the government channelled the medical capitation through principals and it is this money that has been pooled to offer the comprehensive cover so it is sustainable," he said.