Kenyans with heart ailments can now get specialised treatment in 11 major hospitals with help from the National Hospital Insurance Fund (NHIF).
The treatments, including basic heart procedures like unblocking clogged blood vessels for proper blood flow (angioplasty), surgery for pacemakers and valves as well as diagnostic tests (angiogram), are now accessible for NHIF members, most of who have been unable to afford the high fees that private hospitals charge.
The hospitals, including top-of-the-range ones such as Aga Khan, MP Shah, Gertrude’s, Mater, Karen and Nairobi Hospital, will perform the cardiac procedures with NHIF coverage of up to Sh500,000 per patient.
Others are Coast Provincial General Hospital, Tenwek Mission Hospital in Bomet, Eldoret Hospital, Nairobi West Hospital and Kenyatta National Hospital (KNH).
“This initiative aims to help alleviate the treatment burden for households while reducing the waiting period for patients,” NHIF chief executive Geoffrey Mwangi said.
Doctors say constrained blood supply due to excessive build-up of cholesterol in blood vessels, narrowing or blocking the pathway, is to blame for the increase in heart ailments.
Some patients have lost their lives while waiting for their turn to be attended to, mostly in the few but cheaper public facilities with the capacity to offer such treatment.
The Sh500,000 NHIF cover, however, falls short of the cost of open heart surgery that currently stands at a minimum of Sh1.2 million in the private hospitals, including a five-day stay in intensive care unit (ICU).
Nairobi-based MP Shah Hospital, for instance, charges Sh35,000 for every day spent in ICU.
The NHIF said that although the official maximum cover is half a million shillings, the agency evaluates and treats each case differently, meaning the support could rise depending on the situation.
Mr Mwangi said some 391 heart procedures have been performed under the programme, which initially started with six hospitals last October.
So far, Nairobi’s Mater Hospital leads in the number of operations conducted at 220, followed by KNH (99) and Tenwek (68).
Crowding public hospitals
The NHIF reckons that the programme has helped clear a heavy backlog of patients seeking heart treatment, especially at KNH – the country’s main referral facility.
The majority of poor Kenyans have been unable to access such specialised treatment at the top private hospitals, a situation that forced them to crowd the few public hospitals with the capability to handle their ailments.
An acute shortage of heart specialists such as cardiothoracic surgeons, cardiac anaesthesiologists and perfusionists has also been blamed for the high costs and long waiting list.
“There are continued efforts to pair up local hospitals with foreign partners to increase capacities. The NHIF is also considering procuring equipment for surgery and screening,” Mr Mwangi said.
The NHIF in 2015 introduced outpatient cover and enhanced benefits for chronic ailments such as cancer and kidney dialysis after raising the amount that workers contribute to the fund from Sh320 to a graduated scale of between Sh500 and Sh1,700 per month.
Implementation of the programme has, however, been gradual and fraught with challenges, including refusal by top hospitals to handle NHIF-sponsored patients.
The enhanced cover came as a big relief for low-income households that were unable to access treatment for chronic diseases in private hospitals.
The NHIF pays up to Sh500,000 for a kidney transplant and Sh10,000 per dialysis session.
The agency’s records show that dialysis is the single-largest driver of claims, highlighting the growing cases of kidney ailments among Kenyans.
The NHIF paid hospitals Sh839.9 million in the six months to December, up from Sh139.8 million in a similar period a year earlier — reflecting a fivefold growth.
It received 86,776 claims for dialysis sessions in the first half compared to 37,177 in the same period a year ago.
High blood pressure (hypertension) and diabetes are the most common causes of kidney disease.
Cancer patients are entitled to a Sh25,000 cover for chemotherapy session and Sh18,000 for radiology.
Expectant mothers are entitled to a maternity cover of up to Sh10,000 for normal delivery while a C-section delivery is covered up to Sh30,000.