Deal or No Deal? Kenyans Narrate How NHIF Cover Saved Them on a Rainy Day

• Naima Omar, who fractured both her knees within two years d broke her leg said NHIF paid KSh 100,000 for two surgical and one correctional surgery she underwent
• Dena, who was diagnosed with mammary glands cancer, said NHIF’s oncology package paid for chemotherapy, brachytherapy and radiotherapy sessions
• The package that has covered over 240,000 Kenyans was enhanced to cover radiological services like CT scans, MRIs, mammograms, PET scans, bone scans, and lab investigations

In 2019, what had looked like a good day for Naima Omar turned out not to be one she wishes to remember.

She was traveling to Kisauni to visit a patient but when she was alighting from a matatu she fell and fractured her right knee.

She was taken to Hospital and got treated and returned home to fully recover from the fracture.

“I did not get proper treatment then and had to begin physiotherapy sessions,” she narrated.

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Another accident, another fracture

As they say, when it rains it pours, tough times were on the roll for Naima. In 2020 when doing house chores, she fell and fractured her right knee also which rendered her immobile and began using a wheelchair.

Whenever these misfortunes knocked on her door, the greatest worry was the amount of money she needed to pay to get treated and possibly get back on her feet.

The second injury saw her admitted at Coast General Hospital where National Hospital Insurance Fund (NHIF) paid for her treatment, though she had to buy the splint which was inserted to help her heal with support from her family.

“Hospital bills, especially where surgery is involved are outrageous and that was my biggest worry. I however, got relief after I was told that NHIF could cater for bigger portions of my bills and that’s how I got treated,” the 43-year-old human rights defender said.

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All this while, the first injury had not healed well and saw her in and out of hospital.

“In 2021 I went to Mwewa Hospital for operation to insert splint on her fractured leg. NHIF paid for the operation and admission though did not cater for hypertension and diabetes medicine. I bought the splint myself,” she said.

In March 2022, the splint was problematic and had to go back to theatre rectify its position and NHIF catered for theatre fees. All the procedures catered by NHIF amounted to over KSh 200,000.

Naima disclosed that she picked Coast General Hospital as her preferred place of treatment and the bills there were catered by NHIF in the two instances.

“If it were not for the cover which I pay KSh 500 per month I would have had to fundraise the money for treatment and this taught me the importance of having a cover. It is literally saving for a rainy day but I would like to urge NHIF to consider covering for over one surgery per year and also help those with fractures get splints inserted,” Naima said.

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She said that if it were not for up-to-date NHIF cover she would have needed to raise hundreds of thousands to undergo the surgery to treat her knees.

Despite several leg surgeries, she has not been able to walk again hence being forced to use a wheelchair to manage her movements from one place to another.

Every Kenyan should consider having medical cover

“I am grateful for NHIF for helping with my treatment. Though I am not able to walk again at the moment, it really played a big role to ensure I was treated as doctors had advised.

“I was too broke to raise medical bills and the cover saved me. At first paying the KSh 500 monthly subscription felt burdening but after benefitting I can say it is worth for all of us,” she told TUKO.co.ke’s Yvonne Sasha.

Naima currently needs KSh 500,000 for a knee replacement procedure in India saying she had depleted her annual NHIF cover which already paid for her 2022 surgery.

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She already underwent a second surgery which she paid for in cash.

Naima requested NHIF consider covering more than one surgery in a year and expand the outpatient benefits.

She appealed to Kenyans to actively subscribe to the NHIF which she described as a saviour in times of emergency.

Dena’s journey after cancer diagnosis

Dena (requested for a single name use) from Kilifi was devastated in 2018 when a lump in her mammary glands turned out to be cancer.

The magnitude of the unexpected news was aggravated by the amount of funds needed for one to manage the disease.

Dena’s journey is typical of mammary gland cancer survivors.

“I went to a hospital in Kilifi for a check-up because the swollen part kept growing. A sample of the swelling was removed and tested and after the tests were done the doctor confirmed the lump was cancerous,” she narrated.

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Four years later, Dena attributes her strength to valuable support from her family, friends, government health cover NHIF, doctors and above all God.

“These are the reason why I am here today to testify. It was a tough journey,” she said amid sobs.

She explained that her saving grace was courtesy of the government’s sponsorship as a beneficiary of the NHIF cover which afforded her a cancer care package.

Leading type of cancer in Kenya

Kenya’s Ministry of Health’s Br3ast Cancer Screening and Early Diagnosis Action Plan 2021-2025 quotes the GLOBOCAN statistics that place mammary gland cancer as the leading type in Kenya accounting for 16.1% of all cancers.

The report estimated an increase in cases diagnosed in 2020 by 800 cases from 5,985 in 2018 to 6,799 in 2020.

The report further explained that the deaths due to mammary gland cancer rose from 2,553 in 2018 to 3,107 in 2020, making it the second leading cause of all cancer deaths in Kenya.

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TUKO.co.ke found out that NHIF caters for the hospital bills of an average of 5,000 women diagnosed with this type of cancer annually.

During the financial year 2019/20, 2,216 women received treatment for mammary gland cancer and made 13,965 total visits to healthcare facilities using NHIF cover.

Rising numbers of NHIF beneficiaries

According to NHIF, the numbers are rising courtesy of increased awareness creation and so far approximately 23,249 visits to access mammary glands cancer treatment were recorded in the financial year 2021/22.

Dena’s story captured a usually overlooked bit of managing the disease which is the psychological and financial strain the family undergoes when caring for a cancer survivor.

Her journey sheds light on many patients’ situations.

“Many patients are particularly vulnerable to the adverse effects of a cancer diagnosis, especially those with dependents and those who are not working at the time of diagnosis,” she attested.

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The fund sought to increase the scope of benefits to be covered and implement strategies to expand the insured pool by ensuring 100% coverage by 2022.

Oncology cover for cancer patients

It progressively introduced a cover for chemotherapy, radiotherapy and brachytherapy treatment, blood, blood products, and hormonal treatment.

Radiological services include CT scans, MRIs, mammograms, PET scans, bone scans, radionuclide scans, and laboratory investigations.

The benefits are in addition to the existing services such as six chemotherapy sessions, six complex Chemotherapy sessions, two brachytherapy sessions, and 20 radiotherapy sessions, as well as consumables, pre-meds, and post-meds.

NHIF puts the number of Kenyans who have benefited from its oncology package at 240,000 since the cover was introduced in 2016.

Another beneficiary of the oncology cover is Pauline Akinyi from Kisumu.

She said that NHIF has been her trustworthy partner in her journey to recovery since she was diagnosed with colon cancer in 2018 at Jaramogi Oginga Odinga Referral Hospital.

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“In 2018, I was unwell and the doctor recommended an abdominal scan and to my surprise NHIF paid the whole amount. The tests showed that I had a cancerous tumor which was to be removed. Again, NHIF paid for the procedure that would cost me hundreds of thousands,” she narrated.

She said that the cover also saw her chemotherapy sessions paid for by the NHIF cover.

Paul Othin’s daughter’s colon cancer journey

Paul Othin of Kisumu who supports orphans mostly living with HIV/Aids observed that medical covers are heaven-sent because no one knows when they fall sick.

His daughter was diagnosed with cancer in 2018 and despite having much money in their hands, the NHIF cover he had actively subscribed to catered for her treatment to a large extent and saved the family from experiencing catastrophic expenditure.

NHIF medical covers upgrades and Universal Health Coverage

To ensure all members get value for their money whenever they visit health centres, NHIF introduced a standardised reimbursement across all levels.

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It also revised contracts for the hospitals to offer either comprehensive or non-comprehensive care.

Welcomingly, according to NHIF, 87% of hospitals opted for comprehensive contracts where services are available without beneficiaries having to co-pay.

“This is a gain for beneficiaries because it offers NHIF beneficiaries a wide range of facilities within which they will seek care,” said NHIF CEO Peter Kamunyo.

He explained that the standardisation of amounts paid for particular cases had motivated public healthcare facilities to improve the quality of services offered.

He cited Rift Valley Provincial General Hospital and Coast General Hospital which recently undertook their first brachytherapy sessions.

“This is a milestone considering most of these services were not available in many county facilities. Patients had to travel long distances to access them and this meant much expenditure and strain on already scarce resources,” the CEO explained.

He expressed optimism that more progress will be recorded in the coming months and patients and their families will move miles away from the catastrophic expenditure.

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Access to affordable and quality healthcare is both former president Uhuru Kenyatta and his successor President William Ruto’s main agenda captured under the Big Four Agenda’s Universal Health Coverage (UHC) pillar.

“UHC attainment is a step towards financial freedom where all Kenyans will have access to quality healthcare services without suffering financial hardship,” Kamunyo reiterated.

Here is an explainer of what Universal Health Coverage is and how NHIF is a key component towards its attainment as broken down by TUKO.co.ke editorial.

Source: TUKO.co.ke