Shield proposed social heath funds from fraud


The National Hospital Insurance Fund building in Nairobi. FILE PHOTO | JEFF ANGOTE | NMG

As part of the transition to a new social health funding system in Kenya, the current employees of National Health Insurance Fund (NHIF) will be required to reapply for their jobs, if a proposed law is passed.

The Social Health Insurance Bill 2023, which seeks to disband the NHIF and replace it with a Social Health Authority, says “the staff of the Fund [NHIF] are eligible to apply for the positions advertised by the Authority and may be considered for appointment where they are suitably qualified for the positions advertised”.

While the move is understandable considering the well-documented governance issues at the NHIF over the years, it is our expectation that the process will be fair to the more than 1,800 employees and that whatever decision is taken doesn’t offend the country’s labour laws. It is also our hope that the staffing shake-up will include lifestyle audits to ensure that the new funds set to be created under the ongoing reforms don’t inherit the culture of fraud associated with the NHIF.

A parliamentary committee probing claims of fraudulent medical claims and capitation payments to health facilities by the NHIF was told in July that hospitals [in collusion with staff] grossly abused the process by charging two to five times more for generic medicine but indicate the price as it would cost for the original version of drug.

An impact assessment study presented to the NHIF board in 2020 estimated the medical fraud risk was at 29.3 percent of the claims.

The authorities should seize the moment to stop the fraud risk spreading to the new funds.