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Messy NHIF after board directs Kamunyo to reinstate providers

Friday, September 16th, 2022 00:22 | By
NHIF headquarters
National Hospital Insurance Fund headquarters on Ngong Road, Nairobi. Photo/PD/FILE

National Health Insurance Fund (NHIF) board has directed its Chief Executive Officer (CEO) Dr Peter Kamunyo to reinstate 17 health providers whose contracts were irregularly terminated.

The contracts are for the secondary schools medical cover whose implementation has been shrouded in controversy over the years.

Kamunyo terminated contracts of the healthcare providers without involving the board, a move that has prompted the NHIF board chairman Lewis Nguyai to write to him, directing that he reinstates the contracts for the health providers with immediate effect.

In his letter dated September 7, a copy which is in People Daily’s possession, Nguyai demands that he explains why he issued the termination letters without following due process.

Nguyai further asks the CEO to provide a full list of healthcare providers who have had  their contracts terminated or revoked in the last nine months, including the latest list of 17 healthcare providers.

Further, the board chairman has instructed Dr Kamunyo to follow due process in terminating any of the contracts, including preparing a board paper for the attention of the fund’s Operations, Strategy and Information Technology Committee.

Sources at the insurer revealed that the CEO was yet to respond to the letter or effect the directives, one week later and the board has threatened to take action against him, terming it insurbodination. “To date, the CEO has not responded to the letter. This is  insubordination.  We will be convening a  meeting soon to discuss his conduct,” the source said yesterday.

In the letter, Nguyai had also asked Kamunyo to advise all top managers that such action will not be taken lightly by the Board.

“For your information I have received telephone calls from places as far as Kapsabet where there is a real fear that such action will affect the far and wide services that are there thus hampering our UHC mandate,” reads the letter.

Nguyai also alleged that some members of NHIF staff are seeking inducement to have the terminated contracts reinstated.

“I instruct you to investigate and revert to me,” Nguyai wrote.

He noted that he had received two letters from St Joseph’s Nursing Home and Ruai Family Hospital alleging that management effected termination of their contract.

“This comes as a surprise as there are very well stipulated procedures for such action under the NHIF Act revised and amended in January 2022,” notes Nguyai.

Act unilaterally

The board chairman goes on to quote the sections of the law that give the board powers in the empanelment of Healthcare Providers.

“The Board may, at any time, revoke any empanelment under this section. Where the Board intends to revoke the empanelment of a health care provider under subsection, the Board shall notify the health care provider of the intended revocation, in writing, setting out the reasons for revocation of empanelment,” reads the Act.

Nguyai accused the CEO of ignoring this section of the law which could have guided him not to act unilaterally.

According to the NHIF Act, a health care provider may, upon receiving a notification, submit a written response to the notification within seven days.

A health care provider whose empanelment has been revoked under this section may apply to the Board for the review of the revocation in the first instance and, if dissatisfied by the decision of the Board upon review, appeal to the High Court against the revocation.

The NHIF audited contracted healthcare providers between February and March 2022, and according to the CEO, identified irregularities with respect to the Comprehensive Secondary School Students Medical Scheme, popularly known as EduAfya.

Dr Kamunyo says that acting on the investigative reports, he cancelled the contracts of the providers, a decision that the board has challenged on grounds that it was beyond his powers.

“In view of this, the NHIF has deferred offering you the Health Care Provider contract for the contracting cycle 2022-2024 on the basis of the investigation reports,” he said in the letters dated August 30, 2022.

 The EduAfya scheme controls billions of shillings given that the government pays premiums of Sh1,350 for each pupil in public schools.

The scheme was unveiled during retired President Uhuru Kenyatta’s second term in office and was part of the Jubilee administration’s Big Four agenda of offering universal health coverage (UHC).

To implement the scheme, the Ministry of Education contracted the NHIF to offer medical insurance to learners for the duration of their study to ease the healthcare burden on parents and guardians.

Under the plan, the government pays a premium of Sh1,350 that is deducted from the learner’s capitation to allow them to access outpatient, dental, inpatient, optical, emergency, road rescue and overseas treatment.

The money is part of the Sh64.4 billion allocated for free day secondary education for the year to June 2023.

The medical cover caters to any student who is in a public secondary school captured under the National Education Management Information System (NEMIS) database and registered with the NHIF.

The differences between the NHIF management and board could affect the implementation of UHC, at a time some 660 hospitals have threatened to withdraw outpatient services in protest over capitation rates and delays in signing contracts.

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