Sick Kenyan students stuck in India as Edu Afya cover dries up
Health Cabinet Secretary Susan Nakhumicha.
“I live like a bird, but at least a bird has a nest on a tree – I have no place to lay my head when night falls,” Tophister Ong’onga tells the “Nation” via a phone call.
For two months now, Tophister, her daughter Rachael and a son have been in India to seek medical attention at the Sanar International Hospital.
On the other side of the phone, she is distracted by people with a heavy Indian accent. They are shouting at her, but she is focused on our telephone interview.
“I am sorry. They are asking me to move my luggage elsewhere. I don’t have a place to sleep for the night. My mind is full and I don’t know where to go. At the top of my mind is a place I’d get to prepare porridge for myself, my ailing daughter and my son who is by my daughter’s bedside,” narrates Tophister.
She left Kenya for India after a doctor at Moi Teaching and Referral Hospital referred her to the facility when her daughter’s hip bones started degenerating due to sickle cell disease.
She was assured that the Edu Afya Medical Scheme — a high school student medical cover that was under the defunct National Health Insurance Fund (NHIF) — would cater for her treatment cost.
Rachael was born 18 years ago, and when she turned three, she was diagnosed with sickle cell disease. Last year, she should have completed her Kenya Certificate of Secondary Education at St Anne’s Girls’ Kisoko in Busia County but she was in a hospital bed when her classmates were sitting the national exams.
She is one of the 3,000 candidates who registered for last year’s national exams but missed out because of sickness.
Medical costs
Tophister tells the “Nation” that the first month in India was smooth, but around December 5 last year, she was notified that their medical costs would come to an end on December 31.
“I was confused because I don’t have money to pay for the hospital bill out-of-pocket. I knew that Edu Afya cover would cater for everything,” she tells the “Nation”.
On December 6, she was discharged but later recalled and Rachael was treated until the last day of 2023. Her daughter needed at least 24 more days of care. Their visa and accommodation payment also lapsed at the same time.
As of January 9, Tophister had a bill of about Sh900, 000 since her daughter’s re-admission for seven days.
In the same hospital, Rhoda Masolo is also with her 18-year-old daughter whose script reads like Tophister’s. She arrived in India in September last year and her daughter’s treatment started immediately. Two months into treatment, the hospital informed Rhoda that her medical bills would cease being paid by Edu Afya. She now has an extra bill of Sh2 million.
“I exhausted all my funds and now live like a squatter,” she tells the “Nation”.
Her daughter, Caren, was also to sit her final exams at Namgoi Secondary School but she missed out.
Stranded in a foreign country with dwindling hope on who will foot their bill, these two mothers and their children are not alone. The “Nation” saw a letter written to the Ministry of Education on January 9, asking the way forward on the treatment of another Kenyan student.
“We have students here at the ICU, what will happen? Some still need blood transfusions…What happens if that stops?” Tophister asked.
Kenyan hospitals have also received a circular from NHIF stating that students covered under the Edu Afya Medical Scheme will not be eligible to be covered after December 31.
Health Cabinet Secretary Susan Nakhumicha said at a press conference that claims for the scheme were going up every year, and linked it to fraud.
In January last year, during her routine check-up at the Moi Teaching and Referral Hospital, a doctor also asked her to consider taking her daughter to India for a Bone Marrow Transplant.
It wasn't until July that she got a passport and was ready to start her medical travel processes. She arrived in India in September and her daughter’s treatment started immediately.
Almost two months into the treatment, the hospital informed Rhoda that her medical bills would cease being paid by Edu Afya. She now has an extra bill of Sh2 million which she is expected to pay out-of-pocket.
Namgoi Secondary School
“I exhausted all my funds and now live like a squatter. I walk with my luggage everywhere. I don’t have a place to stay at the moment and so the hospital is my only accommodation,” she tells the Nation.
Her daughter, Caren, was also to sit for her final exams this year at Namgoi Secondary School but she missed out.
The two are now stranded in a foreign country with dwindling hope on who will foot their bill after their daughters are discharged. They are not alone.
Their story comes barely two weeks after Kenyan hospitals also received a circular from NHIF that students covered under the Edu Afya Medical Scheme will not be eligible to be covered after December 31.
When the Uhuru-backed funds operationalised in 2018, it came as a relief to parents like Tophister and Rhoda whose children have chronic illnesses and needed treatment while in school.
Only students enrolled at a public school and had registered their names in the National Education Information System (NEMIS) portal, were eligible for the fund.
The caveat for overseas travel to be catered for under the scheme is only for treatment that is not available in Kenya and that there needs to be preauthorization from NHIF and the Director of Medical Services.
Reacting to the culmination of the Edu Afya scheme, Health Cabinet Secretary Susan Nakhumicha said at a press conference that claims for the scheme were going up every year since its introduction –linking it to the NHIF fraud where hospitals colluded with school nurses to get Edu Afya claims.
She said that every year, the government was pumping about Sh4.6 billion to the scheme.
Healthiest population
“When Edu Afya began in 2018, the loss ratio, or what was claimed, was about 52 per cent. The following year, it rose to 69 per cent. The numbers went down during Covid. But, in 2022 and 2023, we saw a sharp increase. Last year alone had a 142 per cent increase,” she said.
“Generally speaking, the people you see in high school are the healthiest population. It is rare that they would have conditions that would require attention, except during emergencies and maybe, some who may have chronic illnesses,” she added.
The CS said that under the Social Health Authority, the government will cover everyone at the household level, emphasising the scrapping of the student scheme.
“What Edu Afya did was that it covered students and forgot that those students come from families and they depend on their parents. This will be streamlined once registration at household level will be conducted,” she said.
In a letter seen by the Nation yesterday, another hospital in India treating a different student wrote to the Ministry of Education on January 9 inquiring to know the way forward regarding one of their patients.
The letter from Manipal Hospitals in India details that the patient still needs medical management in about four to five days but they are not able to pay because they do not have any money with them.
“As per the patient’s mother, she does not have money to bear the expenses for medical treatment as well as accommodation and our hospital is ready to support her to some extent but we cannot waive off the complete medical bills amount,” read part of the letter.
Tophister also intimated to the Nation on Tuesday that, unfortunately, the hospital informed them that their patients will not be attended to if they are not able to pay for the medical costs.
“We have students here at the ICU, what will happen? Some still need blood transfusion…what happens if that stops?” she asked.
