OIL-LAMP WARNING SIGN
I was hurtling down Thika Road in my silver Vanguard coming from my busy Gynecology Outpatient Clinic (GOPC) in a rural level 4 Hospital called Kigumo Subcounty Hospital, when I approached a bump and hit the brakes. On the dashboard, for a split second, I noticed the oil-lamp warning light go on when I braked and immediately disappeared when the brakes were released. Unconsciously, my brain took note on that. Later, the split second oil-lamp warning light phenomenon repeated itself. My mind was going through the possibilities of what could possibly be wrong. After all the car was moving fine. Is it brake fluid? Is it oil? Is it coolant? It was late at night and I was too tired to check. I rationalised that the car needed to be cool for the true picture to come out. I slept. In the morning I woke up early and opened the bonnet. The coolant was fine. The brake fluid was fine. There was no oil. I drove on free to the nearest petrol station and put 3l of oil. The car even felt more powerful. I had averted a heating up of the car that would have blown a gasket. Had I continued driving and ignored that warning sign a far more expensive affair would have occurred. Prevention is far better than cure.
DO NOT IGNORE WARNING SIGNS
The lesson was that we should not ignore the warning signs, however short-lived and subtle they may be. About your health, that cough that is disturbing you, get it checked. That bleeding that you have noticed on the vulva, get the gynaecologists to reassure you that it is ok. Do your pap smear. We offer this at @excella healthcare. Do your mammogram. Do your wellness check. Prevention is better than cure.
SHA WARNING SIGNS
That brings me to the warning signs of the Social Health Authority (SHA). SHA was launched with promises of heaven and earth for Universal Healthcare for Kenya. It was pushed on the back of demonization of a 65 year old National Health Insurance Fund system that was generally being improved literally every year.
We started noticing the warning signs even before the SHA system was deployed.
A court case delayed the initiation of SHA. Many people including yours truly pointed out many issues that we felt were warning signs before its launch. We were ignored.
SHA System Contracting
The contracting for the system was a little off. Single sourced with no public participation. Yet we have been having functional NHIF system and other private ones. It was deployed in a hurry. It failed and some emergency patch up work was done with the help of another entity at a cost to the tax payer on top of the contractual cost.
Slowed payments, NHIF Staff Insecurity
After a long court battle SHA was pushed through. NHIF was disbanded in record speed. The slowing down of payments to providers started as staff at NHIF got job insecurity. That was a major warning sign.
Benefits Package not commensurate with Premiums
Then came the benefits package which were obviously less than those of NHIF and private insurers for the premiums they charged. Behind a flawed reasoning that ‘the rich should pay more’ they pushed a tax of 2.75% of gross earnings. This was unjust because the only people they could get were already paying 30% PAYE and supporting a larger informal sector as black tax. There are persons contributing almost a million shillings for no benefits literally. There are the other 80% who are not contributing due to an opaque means testing. Then the politicians go out there and say that the ‘rich’ are obstructing healthcare of the poor. Robin-Hood style theft. Talk of natural justice.
Middlemen paid before / instead of providers
The suppliers of the invoicing transmission system gets paid before the provider who provided the service.
DHS Reject system
The invoice then goes to a DHS system designed to REJECT claims. Never in any country have you seen a system boasting of rejecting claims. But what is the effect of rejected claims. Livelihoods are lost, hospitals are closed, unemployment is increased. Worse still there is NO RECOURSE for rejected claims. This is pure theft. THAT is a MAJOR WARNING SIGN. Was the system designed to collect money, pay system people and invoice transmitters on the back of REJECTED and UNPAID CLAIMS and delayed payments. Time is telling.
Fraud narrative
Then comes the claims of fraud, a very clever way of diverting attention from providers. Whereas fraud is present in any insurance process, weaponizing fraud to avoid paying genuine claims is the tactic that has been deployed by non other than the CS of health. The fraud narrative is thrown at you when you raise questions. We have not seen any so called ‘fraudulent’ facilities taken to court. In fact many of those claimed to be fraudulent have been found to be operating legally. No apology is done for their defamation.
Parliamentary Committee on Health Inspections
The warning signs are everywhere for SHA. The Parliammentary Committee on Health went round the country looking at SHA implementation. Read their report. Warning Signs. The interaction between an MP and the CS of Health in Parliamentary Committee meeting was telling. And note the fraud card was thrown in there. The interview of the Catholic Church Hospitals recently is telling. They warn of closure of the health facilities due to NHIF/SHA non payment. RUPHA cut their losses two months ago and stopped seeing SHA.
Nhif legacy debt
The warning signs of SHA are all over. Unpaid NHIF legacy debts by SHA as they enjoy the assets is a big warning sign.
Increased out-of-pocket expenditure
And finally the massive increase in the out of pocket expenditure for healthcare despite the promise of SHA Canaan.
THE REJECT SHA BUTTON
The REJECT button of SHA is the basis of REJECTION of an incalcitrant government, tone-deaf to the health providers. Like the oil-lamp dashboard warning sign, SHA warning signs are all over. Unless the politics of SHA changes in the next two months the light at the end of the tunnel is a an oncoming train.
Dr Simon Kigondu is an Obstetrician Gynaecologist and the President of Kenya Medical Association