Clinical officers have threatened to down tools after a dispute with the National Hospital Insurance Fund over accreditation rules and prescription limits escalated in Nairobi. The row, reported on Wednesday, November 21, 2018, centres on NHIF’s refusal to recognise procedures ordered by clinical officers, including CT scans and X-rays.
The Kenya Union of Clinical Officers said its members would not accept a requirement that they register with the Kenya Medical Practitioners and Dentists Board so that patients treated by them can receive NHIF cover. The union also objected to NHIF restrictions that bar clinical officers from referring patients for imaging and that impose pre-authorisation limits on procedures such as cataract surgery and Caesarian section.
KUCO gave the insurer 14 days to withdraw the policies or face industrial action. In its notice, the union said: “Clinical Officers Council (COC) is our regulatory body. Our members register and get accreditation to open clinics and treat patients from the body.” It added: “No law compels clinical officers to register with other bodies, making NHIF demand discriminatory,” according to secretary-general George Gibore.
Mr Gibore said the policy affects not only private practitioners but also clinical officers working in public hospitals. He argued that the restrictions were delaying access to urgent treatment, saying: “It is denying patients immediate access to life saving procedures and this is unacceptable.”
The union said it had not received similar complaints from private insurers. It also said the extra registration demand had forced officers to limit the services they provide to NHIF-covered patients, prompting a call for the repeal of what it described as a policy that “limits and discriminates” its members.
KUCO said the issue was first raised with NHIF in November 2017, but the insurer had not changed its position even after the Ministry of Health and the Council of Governors intervened. The lobby said 6,000 of its 20,000 members work for the government.
In the notice, Mr Gibore said the union had unanimously resolved to demand that NHIF issue a written undertaking to accredit facilities registered by the Clinical Officers Council, as directed by the Ministry of Health, within 14 days. He said clinical officers should be allowed to practise and serve NHIF-accredited patients according to their training, qualification and scope of service.
Director of Medical Services Jackson Kioko wrote to NHIF chief executive Geoffrey Mwangi in March saying the law did not stop the insurer’s board from recognising facilities registered and licensed by the COC. He said: “…. I therefore, authorise that the NHIF board should recognise the registration certificate and Licence issued by the Clinical Officers’ Council to any health facility for purposes of accreditation.” Mr Kioko also said relevant forms should be amended to include clinical officers identification.
The council is responsible for licensing clinical officers and regulating the teaching and practice of clinical health in Kenya. To qualify for licensing, applicants must hold a diploma or bachelor’s degree in clinical medicine and community health and complete the mandatory one-year internship. Clinical officers are trained to handle general medical duties, including diagnosis and treatment of common diseases and injuries.
