The National Hospital Insurance Fund’s (NHIF) chief executive and the board are in a fierce dispute over the lucrative secondary school health insurance, whose implementation has been uncertain.
According to sources, CEO Peter Kamunyo and Chairman Louis Ngoyai had disagreements regarding terminating contracts with around 17 healthcare providers who participated in the programme.
According to Dr Kamunyo, the NHIF audited contracted healthcare providers between February and March 2022 and discovered errors with the complete medical system for high school students known as EduAfya.
Dr Kamunyo claims that he cancelled the providers’ contracts based on the investigative reports, a decision that the board has disputed because it was beyond his powers.
DR Kamunyo said in a letter dated August 30, 2022, “Given this, the NHIF has deferred offering you the Healthcare Provider contract for the contracting cycle 2022-2024 based on the investigation reports.”
The affected healthcare facilities complained in writing to Mr Nguyai that the CEO of the NHIF had not given them information about the purported violations.
Read: NHIF Abandons Plan To Increase Monthly Contributions For Employees
The board has the authority to revoke healthcare provider contracts under the NHIF Act.
According to the law, the board must notify the healthcare provider in writing of the proposed revocation and offer justification for the decision. The facility in issue must then provide a written response within seven days.
The names of the healthcare providers whose contracts have been terminated must subsequently be published by the board in the Kenya Gazette and at least three other newspapers with national distribution.
According to Mr Nguyai, the NHIF CEO disregarded the protocols. The government contributes premiums of Ksh1,350 for each student enrolled in public schools for the EduAfya programme.
During former President Uhuru Kenyatta’s second term, the initiative was introduced as part of the Jubilee administration’s Big Four aim of providing universal health care (UHC).
To put the policy into action, the Ministry of Education hired the NHIF to provide medical insurance to students for the duration of their education, easing the load on parents and guardians.
Read: 7 Million NHIF Members Risk Losing Cover Over Huduma Namba
The government provides a premium of Ksh1,350 that is withdrawn from the learner’s capitation to allow them to receive outpatient, dental, inpatient, optical, emergency, road rescue, and abroad care under the plan.
The funding comes from the Ksh64.4 billion set aside for free daily secondary education from now until June 2023.
Any student enrolled in a public secondary school, listed in the National Education Management Information System (NEMIS) database, and registered with the NHIF is covered by medical insurance.
The National Hospital Insurance Fund (NHIF) provides medical insurance to all its members and their dependents (spouses and children). All Kenyans above the age of 18 are eligible to join the NHIF. NHIF has 95 fully autonomous branches, satellite offices, and a presence in the country’s 47 Huduma Centers. Each of these satellite offices and departments provides thorough customer service.
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