The National Government has announced the reinstatement of EduAfya Medical Scheme under Universal Health Coverage (UHC) after protests from education stakeholders.
Education stakeholders led by the Kenya Secondary School Heads Association (KESSHA) had on several occasions called on the government to ensure continuity of the programme which paid a premium of Ksh1,350 per student per year.
A statement released after President William Ruto chaired the first meeting of the newly constituted Cabinet at State House Nairobi on Tuesday indicated that the EduAfya will now be broadened to encompass all school going children, extending beyond its current focus on secondary school students.
The National Health Insurance Fund (NHIF) – now Social Health Insurance Fund (SHIF) – ended the Ksh4.5 billion insurance scheme on December 31, 2023, leaving more than 3.4 million learners without the medical cover.
The medical scheme which had been in place for over four years offered comprehensive medical insurance coverage for students in public secondary schools registered in the National Educational Management Information System (NEMIS).
NHIF received Ksh9.5 billion from the government in four years for the programme between the year 2019 and 2022.
SHIF will be rolled out on October 1, 2024, and registration is ongoing. Already, 1.2 million Kenyans have registered and the nine million NHIF members will be automatically transitioned to the new Social Health Authority.
During the meeting, Ministry of Interior CS was directed to help in public education on registration and health benefits through National Government Administration Officers.
EduAfya was of great benefit to students but at the same time marred with fraud. A report by the Ethics and Anti-Corruption Commission (EACC) revealed illegalities in the way the money was utilised.
The report indicated that the list of beneficiaries submitted to the Ministry of Education, which shows data for both capitated and fixed fees for services (FFS) beneficiaries, misrepresented the scheme returns and indicated inaccurate or compromised data.
EACC reported instances of induced demand where some Health Care Professions (HCPs) organised transport to pick up students from their institutions while others held outreach activities in schools to induce demand.
The report further revealed that some students lacked Unified Personal Identification (UPI) numbers, which made it difficult to access benefits, prompting their parents to incur out-of-pocket expenses.
Double registration for some EduAfya members was also reported.
The EACC report further revealed that concurrent outpatient and rebate claims were processed and paid for some EduAfya beneficiaries also covered as dependents under NHIF.
The commission said the weaknesses indicated weak controls in the registration of beneficiaries and administration of the scheme leading to loss and misappropriation of funds.
The EACC recommended sanctioning errant HCPs and a clean-up of EduAfya data to enhance data integrity and accuracy in reporting.
The commission also directed that the Ministry of Education ensures all students are issued with UPI numbers.
By Obegi Malack | obegimalack@gmail.com
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