Students’ health plan on verge of collapse

NHIF Building

The National Health Insurance Fund (NHIF) building in Nairobi. 

Photo credit: File | Nation Media Group

A government-sponsored medical cover for public secondary school students risks collapse due to funding and logistical challenges, a parliamentary report shows.

The success of the Edu-Afya programme, an initiative of former President Uhuru Kenyatta, is under threat due to poor coordination and lack of clear structures to guide its operations.

A brief prepared by the Parliamentary Research Services and seen by Nation shows that the terms and conditions of the scheme for the period between 2018 and 2022 are missing, a fact that threatens the success of the initiative.

The six-page brief prepared to guide the Public Petitions Committee on a plea by Joyce Cherono for MPs to intervene and save the programme says uptake of the cover is still low due to poor communication, awareness and insufficient guidelines from the National Health Insurance Fund (NHIF).

“There have been challenges in the enrolment of students to the National Education Management System (Nemis), from which Edu-Afya gets its data.”

“This is brought about by lack of internet technology, lack of birth certificates for some students and low motivation by school heads to register their students to Nemis. This has caused delays in the use of the scheme as well as lower numbers of students enrolled as projected when starting,” the brief reads in part.

Launched in 2017 through a presidential order, the initiative has led to an increase in health budgetary allocations to the tune of Sh4 billion annually based on a premium of Sh1,350 per student per year.

The Kenya Secondary School Heads Association has claimed that over 800,000 students are yet to benefit from the initiative due to logistical challenges which have locked out many students, especially those in rural areas.

According to the brief, providers of the Edu Afya scheme also experienced challenges in reimbursements of funds as they would receive partial payments without remedy to address remaining balances due to the missing Nemis numbers.

“They would be treated and payment sorted out later. Most of these manual claims have not been paid since NHIF only accepts claims made through the Edu Afya management information system,” reads the brief.

In a bid to make the initiative effective, the parliamentary team recommends that NHIF needs to clarify the terms and conditions of the scheme as it did for the Linda Mama scheme.

“There is a need for procedural clarity in the management of the scheme to reduce procedural delays for participating providers. Terms and conditions were missing in contracts covering the period 2018-2022. This needs to be corrected and can be clarified further by the development of a handbook on Edu Afya by the NHIF as done in other schemes,” reads the brief. NHIF has also been directed to conduct training and sensitisation in public secondary schools targeting students, teachers and parents about the programme.

“The Ministry of Education and NHIF should liaise with stakeholders in accrediting more health facilities,” says the brief.

The parliamentary team has also called on the Ministry of Education to revise its policy on the programme to include the role of school principals in ensuring effective utilisation of the fund.

Further, the team has recommended that the procedure and system of enlisting students into NHIF should be simplified to encourage the utilisation of the scheme.

The Ministry of Education and NHIF signed a contract in 2018 and students started accessing services in May 2018.

For one to access services, the beneficiary is required to present an NHIF membership card or a stamped letter from the school’s principal or a designated official if the student is yet to receive a membership card.

Benefits include outpatient, inpatient, surgical, ambulance and emergency air rescue services.

Optical and dental services are, however, covered only in public facilities as a cost-containment measure. The committee is expected to table its report on the future of the initiative on May 17