Health crisis looms as ministry, NHIF tussle over hospital approvals
A quiet power struggle has erupted between the Ministry of Health and the National Hospital Insurance Fund (NHIF) over accreditation of new healthcare providers.
The simmering behind-the-scenes tensions burst into the open following an outcry by owners of health facilities.
Those who have gone through the process claim accreditation only happens after greasing palms of ministry officials.
The lucky ones, those already in business, have to contend with brazen demands for bribes before their reimbursements are processed.
The tussle was triggered by the roll-out early this year of the Universal Healthcare Coverage (UHC), which is one of the pillars of President Uhuru Kenyatta’s Big Four agenda.
Under the guise of facilitating UHC, the ministry has now usurped NHIF’s role of hospital accreditation, even deregistering some facilities that had been approved.
But NHIF acting chief executive Nicodemus Odongo downplayed the tussle, saying it has never been the fund’s role to license facilities.
“There is a lot of misinformation out there. NHIF has never accredited facilities. That (accreditation) is not our mandate but that of the ministry, whose work involves policy and regulation issues,” he said in a telephone interview with the People Daily.
The NHIF Act talks of “declaration” and not accreditation, said Odongo. “What we do is contract undertaking to do business with health facilities licensed by the ministry.”
Accreditation delayed
But an insider said Odongo last year informed staff that they would no longer accredit hospitals.
“There were instructions from the director himself that, henceforth, they (Health ministry) were to do accreditation. That was late last year during a meeting,” said the NHIF staff who sought anonymity.
This begs the question; who does and has been doing accreditation of health facilities if the ministry is withdrawing the same from NHIF? A number of applicants, whose accreditation has been delayed by up to a year, termed Odongo’s explanation a “ joke”.
“Anytime we make follow-ups NHIF, which solely did the approvals, tells us they are waiting for the government’s approval,” said our source at a Kajiado facility.
Facility owners who spoke to People Daily declined to be named for fear of being blacklisted from doing business with the government.
Efforts to get a comment from the ministry’s Medical Services Director General, Dr John Wekesa, were futile, as he did not respond to our calls and messages.
Those familiar with the accreditation say NHIF has solely been undertaking the task after clearance of the facilities by the Kenya Medical Practitioners and Dentists Council.
The insurer has been sending a team of officers from its branches with an assessment checklist of health facilities and compiling a report for presentation to a committee at the headquarters to decide if a facility qualifies or not.
The list of qualified health facilities is then forwarded to the Fund’s board for ratification in a process that ordinarily takes three months.
“The board was the final stage but since last year, there has been a requirement that the board’s decision must be forwarded to the ministry for approval and that is where the process is stuck,” said a doctor, whose application for his facility has delayed for nine months.
The move by the ministry to have the last word on the accreditation process is said to be part of the government’s measures to tame massive graft at NHIF, which saw some top managers paraded in court. But lack of capacity at the ministry is said to have led to the confusion and delays.
A doctor in Nakuru whose application has been pending for more than a year says the “process has been frustrating”.
Impromptu visit
In an exasperated tone, the medic who is consideration shutting down his facility, says: “The responses are heartbreaking and sometimes rude. You spend millions to put up a facility and forced to dig into your pocket to ensure it is running because NHIF staff can do an impromptu visit and if they find it non-operational, they will disqualify you automatically.”
KMPDC chief executive, Daniel Yumbya, said their mandate as a council is to license all health facilities and NHIF can only “accredit facilities licensed by us”.
“I understand there have been those communications but assuming they (ministry) wanted to (accredit), do they have the capacity?,” he posed during an interview.
Yumbya, however, distanced himself from the matter, saying he was only responsible for the council and not NHIF matters.
“There is something they are not telling us but the Director General (Dr. Wekesa) should say what the position is. He’s better placed to clarify the issue,” he said.
Also, there has been a simmering row between the NHIF and private hospitals following the former’s decision to reduce capitation for treatment, mostly on surgery, which has seen hospitals turn away patients.
Surgical repair
NHIF has reduced capitation for some ailments from Sh80,000 to Sh50,000 and from Sh50,000 to between Sh15,000 and Sh20, 000 while for outpatients, the scheme pays Sh300 per quarter of the year which translates to Sh100 per month.
Operations whose capitation has been sliced include tonsillectomy, haemorrhoidectomy and appendectomy, a common emergency surgery to treat the appendix.
Further, the cost of tuboplasty, a surgical repair of the fallopian tubes, was reduced from Sh80,000 to Sh60,000.
The costs of biopsy, a procedure for providing tissue diagnosis, marsupialisation and Mac stitch, have also been reduced from Sh50,000 to between Sh15,000 and Sh20,000.
Managers of private hospitals complained of lack of involvement by NHIF when deciding on the amounts to be reimbursed.
For instance, with the Sh100 per month, outpatients of chronic diseases such as diabetes, hypertension and chronic ulcers, which cost approximately Sh3, 000 for drugs and tests, are being forced to pay from their pockets, which defeats the purpose of the cover.
For members of the disciplined forces, the scheme covers Sh1, 500 per quarter, which translates to Sh500 per month while top government officials from job Group M onwards enjoy Free for Service (FFS) that enable them to get unlimited cover.
In May, church-owned hospitals, which provide 40 per cent of health services in the country, said NHIF had not reimbursed billions. Catholic Church-based facilities were owed more than Sh1.3 billion, dating back to 2017.
For instance, at the time, Catholic Health Commission of Kenya executive secretary Jecinta Mutegi, said Mater Hospital was owed Sh350 million, Our Lady of Lords Hospital in Mwea (Sh120m), Consolata Hospital Mathari (Sh110m) and North Kinangop Catholic (Sh81m).
Ends.
