Rural hospitals fault NHIF on accreditation delays

NHIF Building in Upperhill, Nairobi. FILE PHOTO | NMG

By LYNET IGADWAH
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Summary

• Rural private hospital operators have faulted the national insurer’s sluggish accreditation of facilities saying it denying Kenyans access to primary healthcare amid the Covid-19 pandemic.
• In the past year, the National Hospital Insurance Fund (NHIF) approved only 411 of the 9,000 facilities cleared and gazetted by the Ministry of Health as functional.
• The Rural Private Hospitals Association of Kenya (RUPHA) said the slow approval pace is limiting medical access to the rural community and increasing medical bills paid out of pocket.

Rural private hospital operators have faulted the national insurer’s sluggish accreditation of facilities saying it denying Kenyans access to primary healthcare amid the Covid-19 pandemic.

In the past year, the National Hospital Insurance Fund (NHIF) approved only 411 of the 9,000 facilities cleared and gazetted by the Ministry of Health as functional.

The Rural Private Hospitals Association of Kenya (RUPHA) said the slow approval pace is limiting medical access to the rural community and increasing medical bills paid out of pocket.

“The NHIF has categorically told us that they have stopped accreditation of health facilities since the country has enough already,” said RUPHA chairman Brian Lishenga.

The association, representing 253 healthcare facilities across 43 counties, said the slow accreditation is “detrimental to the rural community and is an urgent matter that needs to be addressed”.

The facilities in rural and urban cater for the underserved populations in places like Kangemi, Kayole and Kisauni who heavily rely on the NHIF card to access medical services.

The sluggish accreditation of functional health facilities has been blamed on quorum challenges at the NHIF board with reports indicating approval sittings are rare.

In May last year, the board approved 171 of the 9,000 gazetted healthcare facilities, and another 240 in November, bringing the total to 411.

The fund has 8.5 million registered members, according to the 2020 Economic Survey, but a huge number— especially the voluntary contributors — has defaulted on paying their premiums amid layoffs, pay cuts and unpaid leave.

The default rate in the voluntary Sh500 per month contributions category was already high before Covid-19 was reported in the country in March.

The rural private hospital operators in August said they are facing cash flow challenges on pending claims that the NHIF is yet to service.

The claims submitted through e-claim system estimated at Sh5.7 billion are have been in suspension since August 2019.

The e-claims system at the NHIF targeted at weeding out fraud collapsed in August last year forcing it to revert to the manual processing of claims.