State deaf ear cause of SHA/SHIF mess
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Failure by the government to heed advice to use a systematic-phase-out of the National Health Insurance Fund (NHIF) is to blame for the chaos that ensued in the implementation of the Social Health Authority (SHA).
The defunct NHIF had recommended the two institutions first run concurrently, with SHA being gradually implemented to ensure a seamless transition.
The gradual phase out would have ensured the system does not face the challenges it is currently experiencing.
In its exit report, the former NHIF board chaired by Eng Michael Kamau insisted on the need to map out the systems well beforehand to enable the current new system to be implemented seamlessly.
Further it also recommended the transition committee be given ample time to conclude its work before the appointment of a new board on grounds that a transition involving critical aspects such as healthcare needs more time, thus the need for critical thought into transitions.
Patient-centred
In addition, it also recommended that all activities be patient-centered knowing that the lives of people depend on the efficient and timely provision of healthcare services by the government insurer adding that members of staff should have been well recognized due to the fact that they are the key to the delivery of health services.
Reads the report: “There is need to consider stakeholder input with a demonstration of either accepting or rejecting it with reasons. Technology should drive business and should be seamless. The two systems (NHIF and SHA) should have run parallel instead of having a direct change over.”
It adds: “Laws and regulations should be sufficiently clear on the transition, especially where two boards exist and are working concurrently during the transition process. There is a need to increase focus on human resources for health and facilities improvement in addition to financing for heath. This will also increase customers and add resources, white focusing on all aspects of health to achieve effective healthcare delivery in addition to ensuring available services within all levels of healthcare.”
The recommendations of the defunct board come hardly days after patients continued to raise concerns over the implementation of SHA.
Last week patients stormed at the Ministry of Health headquarters to express their frustrations over SHA hours after top officials led by Health Cabinet secretary Deborah Barasa concluded a media briefing on the state of healthcare at the Afya House.
A Ms Grace Njoki Mule and Diana Akoth, confronted officials to share their struggles with the new health scheme.
SHA system delay
Mule said there were more than 20 patients waiting for services at the KNH due to delays from SHA systems.“The system has been down since last Wednesday, and nobody seems to care.”
Akoth claimed that she developed complications after Caesarean Section three weeks ago but could not get ultrasound and MRI services. “I’ve paid all the required fees – they even made us pay for six months in advance. But without SHA approval, we can’t get any treatment. I’ve walked from KNH to the SHA offices, trying to get help, but we’re still being denied services.”
In the report detailing, the milestones, lessons learnt and reflections, although the board said there was successful verification of NHIF properties including the main SHA building, parking complex, Meru building, motor vehicles, several inventories; and significant achievements in records management, administration of services and property management, it raised concerns that there were challenges faced due to budget constraints, property maintenance issues, and staff shortages.
According to the board as at December 2023, the amount owed to Healthcare Providers was Sh25.48b while outstanding amounts owed to NHIF by the government were Sh30 billion.
Reads the report: “During the period the Board followed up and further held several meetings with the Ministry of Health, the National Treasury and other key MDAs with a view to realize the more than Sh30b owed to the Fund in outstanding premiums for the various enhanced schemes. The respective MDA’s need to prioritise the settlement of these debts thereby availing the much amounts owed to Health Care Providers.”
In terms of recovery of monies lost after several Health Care Providers were suspected of having defrauded the fund, the former board disclosed that they had recovered from 12 hospitals Sh8,757,082 which was defrauded through the Edu Afya Scheme.
On biometric registration and E-claims, the board said that the fund experienced challenges of capturing biometrics and lack of mechanism for verifying genuine claims.
Reads the report: “This tends to increase exposure to fraud and loss of funds. The Board revamped biometrics to allow for pre-authorization and claims logging and processing. Biometrics was locked to two random fingers as opposed to open 10 fingers, which has eliminated impersonation.”
With regards to outstanding audit issues, the board has named five areas which are pending as some of the cases are pending in court.