National Government Reinstates EduAfya Medical Scheme Under UHC.
The National Government has reinstated the EduAfya Medical Scheme as part of Universal Health Coverage (UHC) following appeals from education stakeholders.
The Kenya Secondary School Heads Association (KESSHA) led calls for the programme’s continuation, emphasizing its importance. The scheme paid Ksh1,350 annually per student.
After a Cabinet meeting chaired by President William Ruto at State House Nairobi, a statement was released confirming that EduAfya will now cover all school-going children. Previously, it had been limited to students in secondary schools.
The National Health Insurance Fund (NHIF), now renamed the Social Health Insurance Fund (SHIF), had ended the Ksh4.5 billion scheme on December 31, 2023, leaving over 3.4 million learners without coverage.
For over four years, EduAfya provided comprehensive medical coverage to students in public secondary schools registered under the National Educational Management Information System (NEMIS). Between 2019 and 2022, NHIF received Ksh9.5 billion from the government for the programme.
Transition to SHIF
The new SHIF will be launched on October 1, 2024, and the registration process is currently underway. So far, 1.2 million Kenyans have signed up, and the existing nine million NHIF members will automatically transition to the new Social Health Authority.
The Ministry of Interior, directed by the Cabinet Secretary, will support public education efforts on registration and health benefits through National Government Administration Officers.
Despite its benefits, the EduAfya scheme faced issues with fraud. The Ethics and Anti-Corruption Commission (EACC) reported various illegal activities in the scheme’s operation.
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Data for both capitated and fixed fee-for-service beneficiaries was misrepresented, leading to inaccurate reports. Instances of induced demand were reported, where healthcare professionals organized transport for students or conducted outreach activities to generate demand.
Key Issues in the Scheme
- Lack of UPI Numbers: Some students lacked Unified Personal Identification (UPI) numbers, which made accessing benefits difficult and forced parents to pay out of pocket.
- Double Registration: Multiple registrations of EduAfya members were identified.
- Concurrent Claims: Some beneficiaries were found to have received outpatient and rebate claims under both EduAfya and NHIF, as dependents.
The EACC attributed these issues to weak controls in beneficiary registration and scheme administration, which led to the misappropriation of funds.
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The commission recommended sanctioning errant healthcare professionals and cleaning up EduAfya data to improve accuracy. It also advised the Ministry of Education to ensure all students are issued UPI numbers to streamline access to benefits.
National Government Reinstates EduAfya Medical Scheme Under UHC.
