The National Hospital Insurance Fund (NHIF) chief executive Peter Kamunyo is facing ouster following a vicious board fight over the lucrative secondary school medical cover.
NHIF board chairman Lewis Nguyai said on Thursday the fund was preparing to punish Dr Kamunyo for insubordination over the revocation of contracts for some 17 healthcare providers under the scheme, escalating the row.
Dr Kamunyo is accused of unilaterally cancelling the contracts amid claims that he usurped his powers and failed to follow the NHIF rules for revoking deals with hospitals.
The fight looks set to offer a peep into the NHIF’s jealously guarded boardroom secrets and could trigger the suspension of the CEO and delay reforms at the fund as Kenya prepares to offer insurance to all adults via the State-backed insurer.
Dr Kamunyo says in documents seen by the Business Daily that an audit unearthed irregularities under the Comprehensive Secondary School Students Medical Scheme, popular 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.
His [Dr Kamunyo] contract ends in April but we will make an urgent decision as a board since his actions border on insubordination,” Mr Nguyai told the Business Daily on Thursday.
“He has not responded to my letter over the revocation of contracts for some 17 healthcare providers. He has refused to respond to claims that staff are seeking inducements to reinstate the contracts. He needs to be disciplined and that we will do shortly.”
The affected healthcare facilities wrote a protest letter to Mr Nguyai, arguing that the NHIF CEO failed to provide them with details of the alleged irregularities.
Under the NHIF Act, revocation of contracts for healthcare providers is vested in the board. The law requires that the board informs the healthcare provider in writing of the intended revocation giving reasons for the decision, to which the facility in question should respond in writing within seven days.
The board is then required to publish the names of the healthcare provider whose contract has been terminated in the Kenya Gazette and at least three newspapers with nationwide circulation. Mr Nguyai says the NHIF CEO failed to follow the procedures and has ignored board orders to reinstate the facilities.
In a memo dated September 7, Mr Nguyai asked the NHIF CEO to furnish the board with a full list of healthcare providers who in the past nine months have had their contracts terminated.
“Finally, there are allegations that some members of NHIF staff are seeking inducement to have these very free contracts of healthcare providers reinstated. Investigate and revert,” Mr Nguyai said in the letter.
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 former 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 enable 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.
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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.