NHIF makes some digital progress but more needs to be done

Tuesday May 26 2020

Our National Hospital Insurance Fund (NHIF) is one of those public entities that are usually associated more with bad news than good news.

Like many parastatals in Kenya, NHIF has not been spared the corruption tag that tends to follow public entities that have any significant levels of funds that could be embezzled or diverted by our ever-insatiable corruption appetite.

However, due to Covid-19, NHIF has tried to digitise some of its functions and is currently offering self-service online portal that could be used by members to complete some basic operations.

Operations like checking your membership and payment status, your inpatient and outpatient medical facilities. The digital platform is also available as an SMS service or a mobile application.

Whereas I could not view nor update my list of hospitals on this portal as recently advertised, I still found it a great effort and a step towards the transparency we need in the public sector.

Furthermore, it is a requirement from the Kenyan Data Protection Act (2019) that all organisations collecting personal data in one form or the other, must provide a mechanism for citizens to view the data.



Whereas the motivation is to accord the citizens an opportunity to ensure the data is accurate and reflect the correct position about them, this same provision could be used to fight corruption.

In the case of NHIF, it is critical that they expand the list of available data in their portal to include the medical claims made against the members’ accounts during any given financial year.

It is quite surprising that this piece of critical information is missing from an otherwise elegant portal and one wonders whether it was deliberate or an oversight.

It is well known that cartels in the insurance industry are able to charge medical claims against members, who will not be aware that their accounts have been used to finance fake hospital admissions, drug prescriptions amongst other medical procedures.

If millions of NHIF members are able to view from the portal the number of claims charged on their accounts, their amounts, dates, medical facilities and other details related to the claim, we would be able to deal with about 80 per cent of the corruption challenges at NHIF.

Information, as they say, is power. Increased information equals transparency, which obviously is the greatest enemy of corruption cartels.

Of course, there will still be some 20 per cent of the corruption persisting despite this level of transparency. It is quite difficult to deal with what we call insider threats or internal collaborators to corruption cartels.

It is quite possible, with the help of ICT departments, to create fake membership accounts and use that to run a syndicate between medical facilities and NHIF to embezzle public funds.

Such a transaction would be in the system but the larger membership will not be able to identify it when they access their online portals.

Ideally, frequent Information System Audits (IS-Audits) are supposed to flag this out, but again, nothing stops IS-Auditors from being compromised to write flowery audit reports – even when the evidence says otherwise.

There are new solutions to deal with insider threats and their compromised IS Auditors but for now, let NHIF provide its members with an online list of medical claims charged against their accounts over any given financial period.

Mr Walubengo is a lecturer at Multimedia University of Kenya, Faculty of Computing and IT.

Email: [email protected], Twitter: @Jwalu