Pressure from education stakeholders has forced the National Government to reinstate the EduAfya Medical Scheme under the Universal Health Coverage. EduAfya Medical Scheme was reinstated after months of appeals by education stakeholders, especially consistent calls from Kenya Secondary School Heads Association-KESSHA, for the continuity of the program. To date, EduAfya covered secondary school students with an annual premium of Ksh1,350 per student.
Expansion of EduAfya to All School-Going Children
But perhaps the most significant change to the programme now is in its expansion beyond secondary schools. In a statement after President William Ruto chaired the first meeting of the newly appointed Cabinet at State House Nairobi, it was announced that EduAfya will now encompass all school-going children. This is huge in the fact that the scope of the scheme has just gotten wider to reach more students across the country with medical services.
SHIF set to replace NHIF in UHC implementation.
NHIF, now rebranded as the Social Health Insurance Fund, had discontinued the Ksh 4.5 billion EduAfya insurance scheme on December 31, 2023, leaving over 3.4 million learners uncovered. For the four years that EduAfya was rolled out, NHIF had received Ksh 9.5 billion from the government to insure students enrolled in public secondary schools through the National Educational Management Information System, NEMIS.
More Kenyans are likely to be covered under the UHC initiative with SHIF rolling out on October 1, 2024. So far, 1.2 million Kenyans have enrolled and nine million members of NHIF will have automatic rollover into SHIF. Public education on registration and benefits of the scheme has been tasked to the Ministry of Interior through the National Government Administration Officers.
Achievements and Challenges of EduAfya
EduAfya has been highly appreciated among students as it provides comprehensive medical cover. At the same time, it has numerous complaints concerning fraud and misappropriation. The report presented by the Ethics and Anti-Corruption Commission explains a few of the following illegal activities that included in the management of the scheme:
- Misrepresentation of lists of beneficiaries resulting in incorrect reporting.
- Induced demand, for example, where transport was organized by the HCPs for the students or outreach activities were conducted at schools to induce demand.
- Students without UPI numbers, thus unable to access medical services on credit and had to pay out-of-pocket by the parent/guardian.
- Duplicate registration cases reported where some students were enrolled twice, resulting in duplicated claims.
- Concurrent processing of outpatient and rebate claims for some EduAfya beneficiaries who were covered under NHIF.
EACC Recommendations to Improve
Against the forgoing challenges, EACC was able to make recommendations that need to be implemented to ensure the integrity and efficiency of EduAfya. These are:
- Sanctioning of errant healthcare providers involved in fraud
- Cleaning up EduAfya data so that it is credible and thus useful for accurate reporting
- Students to be issued UPI numbers to avoid future registration challenges.
Addressing the above-mentioned weaknesses will make this EduAfya scheme effective under the bigger government initiative to cover all students in Kenya under universal health coverage.