Civil servants face healthcare crisis as insurance cover expires

Dr Lily Nyamai Adhiambo doing an eye checkup on Jimna Waweru during a medical camp at Lions Eye Hospital, Loresho. [File, Standard]

Hundreds of thousands of civil servants and their dependents across the country are in a quandary as the contract for their comprehensive medical insurance administered by the ="https://www.standardmedia.co.ke/health/health-science/article/2001495072/verification-of-nhif-assets-liabilities-kicks-off-ahead-of-sha-rollout">National Hospital Insurance Fund (NHIF)< expires on June 30, 2024.

The most likely to be affected by any possible disruption are those admitted or undergoing treatment, both locally and overseas, whose fate is yet to be clarified upon the expiry of the contract period amidst the ongoing transition of NHIF to ="https://www.standardmedia.co.ke/health/health-science/article/2001498009/shif-registration-to-commence-on-july-1">Social Health Insurance Fund (SHIF)<, a civil servants union said yesterday.

State employees with critical illnesses who undergo treatment such as dialysis, chemotherapy and radiotherapy more than once weekly are also likely to be affected.

The Union of Kenya Civil Servants (UKCS), which represents public workers, is now urging the government to move with speed and secure an extension of services as it proceeds with the procurement procedures for the provision of insurance cover for the 2024-25 financial year. 

While Health Cabinet Secretary ="https://www.standardmedia.co.ke/health/health-science/article/2001497760/kenya-secures-sh597-billion-global-fund-commitment-to-combat-hiv-tb-and-malaria">Susan Nakhumicha< and Principal Secretary Mary Muthoni have assured that the public will continue using their NHIF covers even beyond July 1, there has been no clarification over what will happen to those under contracted enhanced covers with fixed end dates such as civil servants, warned unionists. 

“We need clarity to end the apprehension among members,” said Union of Kenya Civil Servants (UKCS) deputy national treasurer Judy Wangari on June 28 in a statement. 

Unlike ordinary covers, members of the enhanced scheme can access hospitals under comprehensive or non-comprehensive contracts depending on their individual allocations. 

“Comprehensive hospitals offer all-inclusive services of all the packages to enhanced scheme members without pay (walk in and walk out). The scope of service covered without out-of-pocket payment,” NHIF guidelines show.

Those on higher allocations can also access non-comprehensive hospitals under Fixed Fee For Service.

To add to the confusion, already the ="https://www.standardmedia.co.ke/article/2001493995/workers-threaten-mother-of-all-strikes-over-terms-for-state-jobs">Ministry of Public Service< has invited bids for the civil servants and disciplined forces health insurance cover, with the closing date stated as July 5, a few days after the lapse of the contract.

UKCS has also advised that the monitoring and evaluation report of the contract with NHIF be considered and the current benefit package to be upheld while awarding the new contract, since members expect an improved level of service, not a decline.

“A healthy and energised civil service translates to better government services,” Ms Wangari said in the statement, highlighting the importance of resolving the looming healthcare crisis.

The rollout of SHIF has been slow due to technical challenges and slow registration by Kenyans due to ambiguities in the system.

Yesterday, CS Nakhumicha said self-registration to the ="https://www.standardmedia.co.ke/health/health-science/article/2001497481/you-will-contribute-to-the-social-health-fund-even-without-a-job">Social Health Authority (SHA)< will start on July 1, 2024, while NHIF contributions will continue until the rollout of Universal Health Cover (UHC). 

A committee appointed by the Ministry of Health recently recommended that the rollout be suspended to allow for solutions to the challenges.

“The ICT experts have been asked to propose alternatives to the ICT system for the SHA, especially in the area of ​​registration and contribution,” the committee said in its report.

“There is need for an alternative solution that also includes the withdrawal of the SHA regulations and the use of NHIF systems, and the latter has financial implications. The nature of the contract with the current NHIF system licenses and contracts needs to be renewed.”

They cited a pilot run in Marsabit County, which the report says exposed significant shortcomings in the technological infrastructure.

The government needs at least Sh5 billion to set up ICT infrastructure for the SHIF, according to Afya House.