NHIF hinders access to essential medicines
It is a Tuesday evening in one of Kenya’s oldest mission hospitals. I have been called here to handle a situation, which, according to the caller, is getting out of hand. I find a dreadful scene. These people here are angry and ready to twist someone’s neck. That twisted neck very well could be mine as they are all holding the prescriptions I have written for them. It is the day when people with chronic diseases attend their follow-up clinics. It is usually a long day, a dawn-to-dusk outpatient clinic. This is the chronic disease capital of the nation.
I approach with caution, surveying what is clearly the scene of a crisis, sinking my neck a tad deeper between my shoulders. I thrust my stethoscope into the coat pocket—in a scenario like this, you do not want anything hanging around your neck!
The long queue outside the pharmacy has stopped. There is a lot of jostling. Angry voices get louder and louder as multiple conversations spring up simultaneously. At the head of the queue, a middle-aged woman is raising hell. She has been at it for a while. She sounds angrier and louder as she goes on, persistent, unyielding
“Why should I pay for the prescription?” She asks, perhaps for the one-hundredth time. Inside the pharmacy, the staff hurdle at the counter, no doubt overwhelmed. The mix of dread and frustration on their faces is unmistakable.
“This is not right, doctor.” She turns to me. Her disposition leaves no doubt she is a hardened veteran life’s many battles.
“May I know what the problem is please?”
“They’ve told me that NHIF could not pay for my medicines. That I have to pay out of pocket.” She says.
I say nothing. I always assumed everyone knows how the national health insurance fund (NHIF) works.
“Look. I have contributed to NHIF every single month of my entire working life. And that’s three decades, son!” She repeats it in slow motion, putting out three fingers for emphasis.
I follow the movement of her hand and settle my gaze on the three fingers. Everyone is looking at them, those three fingers, raised high, the emblem of a long-running injustice.
People are no longer queuing. They surround us, their eyes moving from me to the three fingers and back again. There is the tension that says a severe injustice has been committed, for long, and people are tired of it.
“Now I am told this NHIF card cannot pay for my medicines. After thirty years, I am told this card is useless.” She waves the card in my face.
There is a fleeting sense of unease. Fleeting because while I understand the injustice, I have no part in it. A tall man to my left is looking down on me (literary), his gaze intent, perhaps wondering whether I have any idea how long thirty years are.
I get a sense everyone here shares in the searing frustration of this woman. They would like to thrust fingers in the air. They would like to shove their useless NHIF cards in my face. They want to vent out against an unjust system that has defrauded them for decades. One that has taken their money every month but will not pay for their prescriptions. Prescriptions which I have written. They’d like to shove them in my face too, those prescriptions. I know no one will. But I’d understand if they did.
To them, I am the representation of the health care system. Here, amidst them, I stand for all that is wrong with the system. A doctor is the personification of the health care system everywhere. The problem is, when there’s nothing right with that system when nothing works when people are frustrated, it all comes down on us.
“I understand your frustration,” I say, “but NHIF simply doesn’t pay for chronic prescriptions. Those with chronic diseases have to pay for their medicines out of pocket. It’s just the way it is.”
“How am supposed to stay healthy if they’ll take my money every month but not pay up?” Someone asks from the crowd asks.
“The government does what the government wants.” Someone chimes in from somewhere. In Swahili, that statement sounds far worse than English can convey. The anger and frustration it carries are lost in the translation. You hear it and get a sense that people are ready to take some drastic action, to strike back.
“So, we give up our money for nothing?” It is another rhetorical question.
Multiple conversations spring up in the crowd as people vent out their anger. The woman who started it all narrates to me how she has worked as a high school teacher all her life — doing the hard work. She is a high school principal. In her many years, she says, she has taught many bright students who have made it big in Nairobi, sitting in those high offices where decisions are made. She has always emphasized honesty and concern for others, she says. But look at what she gets for her lifetime of hard work.
“There’s nothing to pay with. They steal all of it. They leave nothing for poor sick Kenyans. It is all in the news.” That comes from behind me. It’s from an older man, a retired civil servant with two prescriptions in his hand. He too paid his dues, in taxes and NHIF deductions et cetera. He contributed to his nation, did his part. Now, with his joints getting stiffer, his hypertension demanding higher doses, his heart failing, he must face it all alone. He must cut deeper into his meager pension, call yet another fundraiser, sell the remaining part of his plot.
Conversations get more animated with the mention of the news. I hardly get time to watch the news myself. I am getting it from them; there is a scandal about loads of money siphoned from the fund.
“It’s an extortion scheme!” Someone retorts. It is a young man who is supporting his grandmother, who is stooped with age. You can tell her back pain is severe. “Instead of paying for our medicines, they hoard the money then take it all, those thieving bastards.”
People are too angry. They are losing their inhibition, losing their glue.
The teacher who started it all shakes her head, takes my hand in hers, and apologizes for the commotion. It is not my fault, she says, rummaging through her purse. This damn NHIF, she says, it is just non-helpful insurance fraud.
As I walk away, a semblance of calm and order is returning as people settle back in the queue, no doubt resigned to the whims of an unjust and powerful monster. The clinking sounds of coins take over as hands rummage through pockets and purses. An overwhelming sadness descends over each of us. It is overpowering, that sense of taking your place among the exploited majority. Everyone retreats into their thoughts, defeated, trying to get a perspective of their predicament.
Trust the bright teacher to put it in perspective; NHIF is the Non-Helpful Insurance Fraud. They didn’t need me to tell them that, after all.