KENYA – The National Hospital Insurance Fund (NHIF) is yet to accredit a majority of Equity Afia clinics, highlighting the mismatch between expansion drive of health facilities and approval timelines.
Equity Afia, the medical franchise of Equity Group Foundation (EGF), says only five of its 41 medical centers have received NHIF accreditation, making the rest inaccessible to patients seeking to pay bills using the national cover.
“We continue to work with NHIF, but they had a period where they were not accrediting new facilities,” said Dr Joanne Korir, general manager for health at EGF. “By end of 2019, we had five facilities. We now have 41 facilities meaning we have expanded much faster than the accreditation process.”
NHIF, which in May, raised an alarm in rising fraud cases across county hospitals, flagged 15 health centers across the country for trying to defraud it of Sh27 million. NHIF chief executive, Peter Kamunyo, said the Sh27,271,028 cases were detected between February and March.
Fraudulent claims have dogged NHIF for years leading to loss of millions of shillings a move that made the insurance provider weary of providing accreditation services to hospitals.
The country has seen an expansion of private hospitals driven by rising demand by the country’s middle class as government hospitals grapple with congestion and frequent strikes.
NHIF had accredited 8,189 healthcare centers by June last year, up from 4,281 in 2017, but hospitals say the accreditation has lagged the setting up of new facilities, especially in rural areas.
Rural private hospital operators in January faulted NHIF’s sluggish accreditation saying it was denying Kenyan’s access to primary healthcare amid the Covid-19 pandemic.
In the past year, NHIF approved only 411 of the 9,000 facilities cleared and gazette as functional by the Ministry of Health.
The Rural Private Hospitals Association of Kenya said the slow approval pace was limiting medical access by the rural community and increasing medical bills paid out of pocket.
The slow accreditation has been blamed on quorum challenges at the NHIF board with reports indicating approval sittings are rare.
By the close of the year ending June 2020, NHIF had 8.9 million registered members from whom it collected Sh58.08 billion, up five percent from the year to June 2019.