NHIF Poor Services to Blame For Loss of The NPS Medical Cover

The NHIF/POLICE tiff began with complaints over poor services. Police for a long time claimed they were receiving poor/substandard services from hospitals through NHIF.

Problem began with NHIF’s claims that the Sh4.5 billion was not adequate. Consequently, NPS gave NHIF an annual Sh 200million ex gratia top up to take care of the excess claims.

For four years NHIF received Sh 4.7 billion to cover 141,000 police and prisons officers but NHIF claimed that this was not enough because they were making 176 % loss value over and above the Sh 4.7 billion premium they were getting.

NPS on the other hand insisted that NHIF was incurring the loss because they were not conducting due diligence when using the Sh 200 million exgratia whose requirement was approval by the NPS based exgratia committee.

NPS demanded for accountability in the use of the Sh 200 million annually over a three year period and sought to deduct the amount from the Sh 4.7 billion after NHIF failed to avail audited accounts for the same.

NHIF have failed to provide evidence of how the ex gratia fund was used and only argued that the amount was used alongside the Sh 4.5bn premium and that the amount was inadequate to cover police.
NHIF did not respond to Auditor General’s queries.

NHIF then officially communicated to NPS demanding Sh 12 billion as premium for the medical cover if they were to continue offering the services. This was the extra revenue matching their 176% loss ratio.The amount was later scaled down to Sh 9 billion but NPS didnt budge.

NPS were concerned that it would take request through a supplementary budget as the 141,461 officers continue to suffer lack of proper medical cover.

NPS consequently resolved to re-tender the cover and invited NHIF to bid like the other interested parties. NHIF bid Sh 9 billion. and demanded upfront payment.

The silent war between the two institutions thus began.

Within a short time and without notice, NHIF scaled down services and denied access to hospitals to over 141,461 police and prison officers. NHIF disabled the systems and denied All of them except 1500 were now asked to seek treatment at public hospitals and only go to private hospitals after referral.

Those with access to special treatment were 39 prison officers in job groups N(14), P(6), R(14),S(4) and T (1).

On the other hand only 1429 police officers from job groups M(455), N(607), P(247), R(97), and S(23) could access the special medical care.

The bulk of police officers under the Sh 4.7 billion NHIF medical cover were locked out leading to thousands of complaints by junior officers.

Instead of negotiating with NPS, NHIF locked out 141,461 police officers and prison officers to coerce NPS to top up. NPS had to seek a stop gap remedy for continuity of services.

NPS had therefore no option but to seek alternative cover for police and prison officers as they sought to resolve the tiff with NHIF.

The most shocking thing was that there was no official communication to NPS about the decision to lock out 141,461 officers. It was only discovered when sick officers were turned away from the hospitals on NHIF’s instructions.

The matter escalated to the cabinet and a decision was made to look for an alternative as NHIF was allowed to put its house in order.

Meanwhile, there was a management crisis at NHIF as the CEO and former chairman Nguyai were involved in boardroom turf wars.

As this was happening, a decision by a middle level manager responsible for claims identified as Dr Kuhora locked out all 141,461 beneficiaries who had unlimited benefit

Critical directors who would have others provided alternative leadership have never been appointed for over four years. Whether that was deliberate or not is a matter to verify.Junior officers at NHIF were left to handle the NPS medical cover crisis.
This gap was filled by private service providers.
Reliable sources reveal that NPS and NHIF have held over twenty meetings including half of them at management level and the other half attended by former Interior PS Kibicho and former IG Mutyambai on issues pertaining to the NPS medical cover.
There were three bidders in the latest tender and NPS picked the lowest.
the new NHIF chairman needs to clean up house and make sure offer reliable services to all public institutions.

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