Why expectant mothers are on their own

Former President Uhuru Kenyatta’s medical programme that had been aimed to cushion expectant mothers is on the verge of collapse with hospitals now threatening to abandon it altogether.

Private hospitals in the countryside have threatened to start billing expectant mothers unless the government clears the outstanding Sh3.1 billion arrears owed to them under the Linda Mama scheme in 16 days.

The Rural Private Hospitals Association of Kenya (RUPHA) has raised the alarm over the National Health Insurance Fund’s (NHIF) failure to remit payments for services offered under the Linda Mama Scheme.

Already, a number of both public and private health facilities are turning away women seeking the services due to lack of funds. Facilities say NHIF has not been remitting to them millions of shillings for services rendered for the programme, which was the brainchild of former First Lady Margaret Kenyatta and aimed at providing support to expectant mothers and infants under the Universal Health Care (UHC) system for the last eight months.

Warning from the private facilities came as reports indicated that several public hospitals have been forced to allocate revenue to sustain services for mothers and their babies.

The financial crisis has significantly impacted operations in hospitals, forcing them to source for alternative funds to ensure expectant mothers are not turned away. Managers of public hospitals, who spoke to People Daily on condition of anonymity due to the sensitivity of the matter, said though they are supposed to receive funding for the programme on a monthly basis, they have not received any money for almost a year.

“For the last 12 months, we have not received any reimbursements, and yet we are expected to continue operating the scheme. We are forced to seek for alternative sources of funds out of fear of being victimised for failing to implement a government project,” a senior medic at the Kenyatta National Hospital (KNH) said.

Association, through its Executive Committee, has written to the NHIF Board of Management, highlighting a breach of agreement and warning of dire consequences if the situation is not promptly addressed.

According to Rupha executive committee chairman Dr Brian Lishenga, the NHIF Board has failed to make the required payments to health facilities for Linda Mama services since July 2023.

In the letter that now lifts the lid on the rot surrounding the outgoing national health insurer, Dr Lishenga has warned beneficiaries of the Linda Mama scheme to prepare to make “top up cash payments to access services, effective from March 18 should NHIF fail to honour their financial obligation.

Lifts lid

 “We wish to bring to your attention a serious matter regarding the NHIF Board of Management’s failure to fulfil its obligations outlined in the Agreement with healthcare providers, specifically clause 12.8 of the contract with providers regarding payments for the Linda Mama Scheme,” the letter signed by Dr Lishenga and copied to the Director, Provider Management, NHIF, the press and Kiskan Law Africa LLP Advocates reads.

Clause 12.8 of the Linda Mama contract between NHIF and healthcare  providers specifies that: “The Board shall make payments to the health care provider for services covered under the Fund’s various schemes in accordance with the Schedules of this Agreement on a timely basis but in any event, Clean Claims shall be paid within ninety (90) days of receipt of the claim from the Health Care Provider, in strict compliance with the provisions of this Agreement.”

“It has come to our attention that as of March 4, 2024 and for the last eight months the Board has failed to make the required payments to health facilities for LINDA MAMA services in strict compliance with the provisions of our Agreement. In addition, a large volume of Linda Mama claims remain locked in the suspended E-Claims system from 2019. This non-payment of healthcare providers represents a persistent and clear breach of our agreement with NHIF,” the letter.

As a result of the Board’s failure to honor its financial commitments on the Linda Mama scheme, Dr Lishenga further stated that health facilities are left with no other recourse but to issue immediate notice that “should the Board not remedy this breach immediately, beneficiaries of the Linda Mama scheme will be required to make Top-up cash payments in order to access services, effective from March 18.”

“We regret having to take this step, but it is necessary to ensure the continued provision of quality maternal and child health healthcare services to our patients. We look forward to a prompt resolution of these issues and the reinstatement of regular and timely payments as per our agreement. Your cooperation in this matter is greatly appreciated,” concluded the letter dated March 4, addressed to NHIF Board Chairman, Michael Kamau and Fund chief executive Elijah Wachira.

Reached for comment, Wachira acknowledged that there was a problem of financial flow, which the government has moved to address.

 “NHIF is apparently experiencing financial crisis that the National government is in the process of addressing. But this will take some time before we are back track,” Wachira said. NHIF’s failure to honour its financial commitments under the Linda Mama Scheme has had a significant impact on healthcare providers, with hospitals cumulatively owed Sh3.1 billion for services rendered.

Small payment

Despite a small payment made by NHIF in February, the situation remains dire, with providers struggling to meet their financial obligations

According to Lishenga, the last disbursement by the Treasury to NHIF for Linda Mama was June 2023.

He warned NHIF’s failure to honour its financial obligations under the Linda Mama Scheme threatens to undermine the provision of essential healthcare services to vulnerable populations

“There was a small payment by NHIF to providers of about Sh300 million in February but this money was “borrowed” from other kitties within NHIF, precisely the monthly statutory deductions kitty. This has had a negative impact on settlement of especially surgical claims. Majority of facilities offering Linda Mama are in rural areas and in urban slums. So, they are really feeling the heat, they can’t keep going. It seems the Kenya Kwanza administration has no faith in the programme despite the massive positive impact it has had on the poor.”

The Linda Mama scheme was designed to assist pregnant women and infants in accessing subsidised or free health services. For some months, card holders of Linda Mama have been experiencing problems accessing services with most facilities describing the programme to be a ‘sham’ due to failure by NHIF to pay them.