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NHIF: Should Patients be thrown out of hospitals?

NHIF Should Patients be thrown out of hospitals

I am a doctor at war. But first, I am a doctor who is a human being. One who feels for the suffering of others. One who believes that all aspects of society and governance should be guided by basic humanity. That no one should have to be robbed of their dignity, or their lives put at risk to make some policy or directive successful. That unless something is there to promote human dignity and save lives, it is not worth anything.

That’s the basis of this war—a war with people who seem to care little about human dignity and human lives.

This war is between me, the chief medical officer in a catholic mission hospital, and officials from the National Health Insurance Fund (NHIF). They have been here too often. They accuse me, and the other doctors, of keeping patients in the wards too long.

I would like to accuse them of being money-loving callus beasts. But I can’t verbalize that. There’s so much a doctor simply cannot say. I swallow my anger and run to the surgical theatre for an emergency operation.

They proceed with their mission. That mission is to rid the ward of any patient who has been there for more than a month. These are desperate patients.

Pressure ulcers

One of them is a young man paralyzed from the waist down. He had an accident at work years ago and sustained spinal cord injury. From the waist down, he can neither move nor feel his body. This is called paraplegia when one is paralyzed from the waist downwards. Yet his is the worst kind, called spastic paralysis in which his muscles go into persistent, painful spasms. Since nerves are the ones that control muscles, any damage that causes abnormal impulses from the nerves may lead to muscle spasms.

His joints are in a permanent, rigid, flexed position. He suffers severe pain from both limbs, and still, he cannot move at all. He lies still, unable to change his position at all. He has been in this state for months. Body tissues are not supposed to be under persistent pressure. If this happens, the tissues die, resulting in pressure ulcers. These pressure ulcers continue to eat into the tissues as long as the pressure persists. The ulceration for this young man had gone so deep as to expose the bones of his hip joints and lower back. It is the most severe form of pressure ulcers and requires months of daily treatment. As long as there is no persistent pressure on the wounds, they can heal. This can be achieved either by constant turning or by using special, air-filled mattresses.

The more significant problem is that the wounds are usually severely infected. When the infection involves the bones, like in this patient, the bacteria can be resistant to even the most potent antibiotic.

We had worked hard on his wounds and were gaining some mileage. He was under NHIF cover, which meant they are monitoring the accumulating bills. It became a tussle when they insisted he must leave whether or not his condition allowed it. I negotiated, being the patient’s advocate I was meant to be. I wrote detailed medical reports to the senior officials when they asked to understand the situation and why it should be reconsidered. I provided every information they wanted, pleading with them that if given a few more weeks, his wounds would be healed, and he could go home.

They didn’t care.

The condition of the patient didn’t matter to them. The fact of a human being suffering so didn’t matter to them. The recommendations of doctors didn’t matter. As I watched the family struggle to push the wheelchair out the gate, I wondered if basic humanity and qualified medical advice didn’t matter, how could we consider this a health care system at all. Was it that we had been overtaken by financial concerns so much as to forget our humanity?


It took only a few days for him to return to the hospital, the wounds severely infected. It looked as if everything we had done prior had been lost. We readmitted him and started, as if from scratch, doing the best we could do, watching over our shoulders for the dreaded team from NHIF.

And sure they came again. They came with fire and fury. A fury that can be expressed only by those who know they inhabit the unquestioned authority of the government. They accused the hospital of using chronic patients to milk the fund. They accused doctors, myself in particular, of unethical practice. They pushed the patient, and others, out of the wards. They could not allow NHIF to be exploited this way. Patients be damned.

NHIF Scandal 

Now, Kenyans love NHIF and do not want it to collapse. We understand that hard decisions may need to be made to sustain it. And we would accept these cost-saving measures except that as we reduce spending on patients, the money is lost in other ways. This saga came in the backdrop of a scandal that had rocked the fund. Huge sums of money embezzled from the fund by the same officials who decried our overuse of the funds.

Besides, all mission hospitals were struggling because the fund never paid them. Business Daily ran an article in May 2019 that the fund owed more than 1.3 billion shillings of unpaid claims going back years. This very hospital struggled every month to pay salaries and to settle with supplies. All development projects had been shelved. You see, most patients in mission hospitals are under NHIF cover. That accounts for more than 80% of all revenues in mission hospitals. When the fund doesn’t pay, these hospitals struggle to function.

I am sure, as, in every situation, the officials had their explanation. But nothing can excuse that more Kenyans are registering for NHIF cover, hospitals are not being paid for services rendered, patients with chronic diseases have to pay out of pocket for medicines, the compensation for surgical procedures has consistently gone lower, and more and more claims are denied every day.

All the while, loads of money disappear from the fund. A fund pooled by mostly low-income Kenyans for whom few choices exist. Kenyans who, like my patient, even when paralyzed must find ways of paying their monthly contributions.

Chasing desperately ill patients out of hospital wards is a low I never believed my society could reach. Having unethical, corrupt accountants govern how doctors and hospitals operate, who gets admitted and which surgery can be performed, is the antithesis of what a health care system should be.

If the measure of a society is how it treats its most vulnerable, ours is a failure. The overthrow of all morality within NHIF means there is nothing sacred in our society. There cannot be, when a government takes money away from its citizens in the name of a mandatory health fund, refuses to pay hospitals, punishes Kenyans as if they have chosen to be sick. Then, the money saved through these unsavory means disappears into private pockets.

This is a sick society—both literary and metaphorically. Unless NHIF is completely overhauled, our health care cannot move forward. Unless ethics and morality are the foundations of our health care reforms, everything will fail.


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