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.
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.
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.
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