Nairobi — The National Health Insurance Fund expects to sign up 100,000 more members, just six months after a comprehensive new scheme was introduced. The majority of new members will be from cooperative societies and agricultural and informal sectors.

The National Hospital Insurance Fund base: Unveiled a scheme through which nearly 1.5 million people will be treated for all illnesses, including Aids, in 380 hospitals and clinics countrywide - without paying a cent.Photo / File

Negotiations have been finalised between NHIF and associations representing jua kali artisans, which expect to bring in some 10,000 members.

The fund has also held meetings with Mumias Outgrowers Company, from where 20,000 members are expected.

Large cooperatives in tea and coffee industries are also expected to bring in new members. In Nyeri, for instance, tea cooperatives have about 40,000 members, half of whom the NHIF management is targeting. Another 30,000 are expected from tea cooperatives in Kericho.

Even the matatu industry is currently holding talks with NHIF officials to join the scheme. Matatu Welfare Association chairman Dickson Mbugua confirmed they had held several meetings with NHIF to work out ways of joining the scheme.

He said the matatu industry will have 150,000 workers and vehicle owners joining up.

Anticipating the swell in membership, the fund is seeking actuarial science consultants to advise it on new products and quality services.

Last month, the fund invited bids for consultancy services on new products, including provision of outpatient schemes.

Companies with experience in actuarial studies or medical financing are expected to advise on implementing the new services.

Acting chief executive Richard Kerich said: "Provision of consultancy services for NHIF's new products must have a wealth of experience in actuarial studies or medical financing."

Deadlines for the applications is November 21.

The development comes about six months after the fund launched comprehensive medical cover for members, a move that has thrust its products to the spotlight.

Faith-based healthcare facilities praised the new line of managing services of the fund, saying many Kenyans would now have a chance to access quality treatment.

Through the Christian Health Association of Kenya head Samuel Mwenda, the organisations said consultants would help the fund base its decisions on more informed data.

Previously, the fund could not determine the preferred benefits and risks involved in its operations because it did not seek experts' views, he said.

"We are extremely excited that NHIF is getting a new lease of life. Such services are long overdue. Now a bigger number of poor Kenyans will be able to access medical care," Dr Mwenda said. His organisation caters for 40 per cent of patients in the country.

Medical care has to be paid for in one way or another since Kenyans are too poor to afford treatment for chronic diseases like HIV/Aids, he said.

It means NHIF will take away a big burden from ordinary Kenyans through the new products. Unlike private healthcare firms, the fund does not discriminate against people with certain ailments, he said.

Dr Mwenda added that the entry of NHIF in the sector would encourage competition and bring down the charges.

Currently, the charges are not regulated, unlike in other countries where there are guidelines on what medical practitioners can charge, he said.

Recently, NHIF unveiled a scheme through which nearly 1.5 million people would be treated for all illnesses, including Aids, in 380 hospitals and clinics countrywide - without paying a cent.

Under the programme, to which the biggest referral hospital in the region, Kenyatta, signed up recently, medical cover will include the cost of drugs for in-patients for up to six months. But this will not include treatment in private wings of public hospitals.

The expansion of the scheme follows the introduction in June of health insurance for care in general and maternity wards for non-surgical cases, although caesareans for women having difficulties in delivering the normal way will be covered.

Hospitals taking part in the scheme are either public, mission or private. The scheme will be extended to 501 hospitals accredited to NHIF countrywide.

Each of the 70-plus districts has already been offered between three and five hospitals that would treat NHIF members.

With help from the Ministry of Health, the referral system is being streamlined to ensure only provincial hospitals and one referral hospital - Moi at Eldoret - will send cases to KNH. Patients far from the provincial hospitals will be sent to the nearest, most comprehensive facility.

The fund aims to pay out Sh1.2 billion in the next financial year, up from Sh800 million.

It has already abolished the 65-year age limit for medical cover and has asked retirees to take advantage of reforms and join. It would also cater for jua kali workers.

Under it, retirees and such workers would pay a minimum Sh160 a month - Sh1,920 a year - to receive medical insurance.

Clinics and hospitals are classified in three categories: A, B and C. Category A includes all government hospitals, which would provide full and comprehensive cover for maternity and diseases, including surgery.

Category B covers most mission hospitals and small private hospitals, where patients will receive full cover, except those needing surgery who would be required to meet part of the cost.

Category C covers high cost private hospitals, where patients will continue paying as they did under the previous system, where the fund provided specified daily benefits.

Players in the health care industry welcomed the new comprehensive medical cover, saying it would benefit more people.

The fund enjoys a huge membership because all employed people in Kenya must join it, as stipulated in law. There are currently 3,500 employers who are registered with the fund, out of a possible 4,000.

Introduction of the programme is an improvement on the benefits to contributors, said the chairman of Kenya Hospitals Association, Dr Kanyenje Gakombe.

In the past, the fund used 20 per cent of the contributions to finance healthcare and 80 per cent to run the scheme and fund non-core activities.

The NHIF management, said Dr Gakombe, had realigned the fund to take up its proper place in healthcare financing. He said there would be no competition for clients served by private health care providers.

"I don't see many people shifting to NHIF. Those to benefit from the new scheme are those who were not covered in the first place," he said on telephone.

He said the Government should come up with a legal framework for pooling together resources for healthcare.

APA Insurance chief executive officer Ashok Shah said the scheme would provide a chance for improvement of services. He called on the Government to include an exit clause in the NHIF Act to allow people with other covers to opt out if they so wished.

Avenue Health Management Services chief executive officer Amit Thakker said: "The same amount of money collected will now be used to provide the service, which is an indication that it was inefficient and unable to meet the needs of its members, owing to corruption and mismanagement."

The changes were long overdue, he said, and asked the Government to make membership to the scheme voluntary.

Last year, the fund announced an increase in the minimum Sh800 paid each day to in-patients in public hospitals. Patients admitted previously received between Sh800 and Sh2,000 a day.

Mr Mbugua said workers in the matatu industry were keen to join the new comprehensive scheme as they had previously relied on fundraising (harambee) to meet the cost of medical bills, especially after being involved in road accidents.