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Sunday, April 30, 2017

Kenya’s health sector better off, but yet to heal

A few weeks ago, I had a bit of look at the health insurance sector in both Kenya and Uganda for a client. My client was particularly interested in the national health insurance operator, and I came across two surprising things: First, that Uganda doesn’t actually have one. Apparently Uganda hasn’t gotten round to setting up such an institution, despite looking into this, with study tours and feasibility tours and private sector consultations and the full shebang, since the 1990s. Yes, they started talking about this roughly 20 years.

Kenya, on the other hand, also had a surprise for me: that the National Hospital Insurance Fund was actually not too bad. Of course there are issues – fraud, for example, is a huge challenge across the industry. But overall, here’s an institution that seems to be doing what it says on the tin, and also seems to be getting better at what it is supposed to do. For example, it introduced new benefits packages for patients with chronic illnesses. It will now offer payment for specialised surgeries, and will finance treatment in India if the necessary services cannot be obtained in Kenya. This means that in Kenya, you have options: if you earn a solid income, chances are that you will purchase private insurance. But with a lower salary, or an income in the informal sector, the NHIF actually has something to offer.

And because Kenya has a thriving mobile money sector, and generally lots of companies and people experimenting with mobile technology, there are several initiatives to bring health insurance products to non-NHIF clients.

So this analysis left me slightly befuddled about Uganda, and a bit pleased with Kenya. That didn’t last very long: The many, many questions about the spending of around Sh5 billion in the Ministry of Health were a potent reminder that the poorest will be taken advantage of yet again, while the distinctly not-so-poor and very well connected will claim to be the disadvantaged and the do the taking advantage of. What’s new?

Do I expect any credible follow up here? Not really. Not after watching the NYS circus unfold. It turns out that you can set up a round of briefcase companies called, quite literally, Hocus Pocus Ltd, Incinerate Your Taxes Ltd, and Grand Theft Auto Ltd, and make off with Sh1.6 billion. The President says his hands are tied, his Deputy – who never struck me as particularly interested in transgender issues – tells us that the President cannot have a sister who is a man. Not that this is of any relevance. Me, I’m lost.

The writer is an independent analyst


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