Elijah Wachira: Former CIC General Insurance Managing Director takes the helm at troubled NHIF

Elijah Wachira is the newly appointed NHIF managing director. PHOTO | POOL

The National Health Insurance Fund (NHIF) exists to provide medical insurance cover for Kenyans but has struggled to cover itself against staff-driven fraud.

The game of musical chairs has not stopped at the NHIF but so has that of accusations and counter accusations of fraud even as many members struggle to get value for the monthly premiums they pay towards health insurance.

This is the environment that Elijah Wachira, the newly appointed NHIF managing director, is walking into as he takes over the mantle at a time when the government also wants to scale up the delivery of affordable healthcare for all.

Read: The good, bad of Social Health Insurance Bill

Mr Wachira, a seasoned insurer, has previously worked at private insurers, including CIC General Insurance where he was the managing director between 2015 and 2019, leading the firm in growing annual premiums from Sh7.9 billion to Sh12 billion.

He also served for three years as general manager at AAR Health Services before joining Madison Insurance in November 2010 in a similar capacity. He then moved to Gateway Insurance.

Mr Wachira, who until his latest appointment was a business development and insurance consultant, now hopes to ride on his experience to put the NHIF house in order and succeed on a terrain others have found slippery.

The NHIF has battled allegations of staff-driven fraud, with many insured patients complaining of delays in approval of medical bills and payment. There have also been complaints of lower approvals forcing the insured to top up hospital bills and buy drugs.

Mr Wachira will be at the centre of helping NHIF transition into the new fund that will phase out the State corporation that was established in 1966.

But at the same time, he will have to ensure the millions of Kenyans dependent on the fund get value for their premiums.

He is coming in alongside six other people to head key functions such as beneficiary and provider management, internal audit and technology.

“The new management team brings on board an invaluable wealth of experience that will immensely contribute to the transition of the Fund into its successor,” said Michael Kamau, the NHIF board chairman.

Mr Wachira faces a delicate balance disbanding NHIF and creating three new funds without disrupting health delivery.

The Social Health Insurance Bill 2023 seeks to disband NHIF and create a Social Heath Authority that will be in charge of three funds—primary healthcare fund, healthcare fund and emergency, chronic and critical illness fund.

Mr Wachira holds an MBA in Strategy and Marketing from the University of Nairobi and a Bachelor of Arts from Egerton University.

He is a member of Chartered Insurance Institute (CII) of London and Marketing Society of Kenya (MSK).

Mr Wachira has a wealth of experience in general insurance business in both Kenya and the East African Region. He is a specialist in strategy formulation and implementation.

He finds a staff of over 1,800 people who have been thrown into panic mode, with the transitional clause in the Social Health Insurance Bill requiring current NHIF staff to apply for jobs afresh and only get hired on merit when the NHIF gets disbanded to pave the way for the three funds.

The proposal has unsettled many NHIF workers.

More Kenyans have been enrolling for the national cover, thanks to a sustained government campaign, taking the number to 15.4 million by the end of June last year.

Health Cabinet Secretary Susan Nakhumicha said mid-June the State was going to conduct a lifestyle audit on all the NHIF staff in a crackdown on staff-aided fraud.

Her sentiments came on the back of the suspension of eight NHIF branch managers following accusations of deploying orthodox tactics to exploit the insured and the Fund.

“We are going to commence an elaborate lifestyle audit on all staff of NHIF. This is to ensure that each member of staff can explain their wealth portfolio inconsistent with their earnings,” said Ms Nakhumicha then.

This audit, as well as the government’s desire for a fresh start in running social insurance, means Mr Wachira will have a critical role in calming the staff and getting full commitment to their work in build-up to the transition to the three proposed funds.

The NHIF has struggled to find stability even as millions of Kenyans continue to depend on it to pay healthcare bills and rescue them from out-of-pocket spending.

Mr Wachira is succeeding Peter Kamunyo, the medical doctor who made strides to cure the many governance challenges that have become synonymous with the 57-year-old State corporation.

Dr Kamunyo’s exit at the end of his term saw the board pick Samson Kuhura to serve on an interim basis.

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The medic had taken over the NHIF helm from Nicodemus Odongo, who had served in acting capacity following the ouster of Geoffrey Mwangi over alleged corruption.

Charges over abuse of office by Mr Mwangi were dropped early this year. His predecessor, Simeon ole Kirgotty, who completed his three-year term was sucked into a corruption probe and charged after exiting.

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