The little-known State agency, the Digital Health Agency, put out an advert in last week’s Sunday Nation to introduce a new animal by the name- The National Information Health Exchange.
All public and private health care providers have been asked to start building applications to enable them to connect to the information exchange. What is it all about?
An information registry that contains all data on all health providers and on activities of all professionals, that connects to a portal with data on all medical records, including statistics on all hospitals in the market, services they are capable of offering, all patient interactions and data on activity at the Kenya Medical Services Authority.
The promoters of this new regime are touting it as a system that will enable what they describe in jargon as medical records portability. That it is going to be the single source of truth on all medical data.
I went to the latest report of the Auditor-General on the National Hospital Insurance Fund (NHIF) to read what is said there about the accuracy of medical data — how it is impacting service delivery and effectiveness of the national health insurance provider.
That report reveals the NHIF has been losing billions of shillings because the technology and system it uses does not generate accurate statistics and data, even on information as rudimentary and basic like member numbers, names of hospitals and employer codes, and number of patients receiving service.
There are instances where billions are lost because hospitals are paid claims that are way above set limits, and where irregular payments are made to hospitals for major surgeries when they have no capacity. The report catalogues duplicate payments for C-sections and normal deliveries, duplicate claims with same medical procedures on same admission dates but different discharge dates.
The auditor highlights 28,000 claims where the same patient was admitted in different hospitals at the same time, and instances where different hospitals had the same name but different outstanding amounts and different hospital codes.
Clearly, if the health information exchange system works, and is implemented well, it has what it takes to be a game changer. But major hurdles lie ahead. In the first place, the controversy over the constitutionality of some aspects of the legal framework underpinning the government’s universal health coverage programme, including the specific Acts of Parliament which were introduced such as the Digital Health Act, the Primary Care Act and the Facility Improvement Financing Act, is yet to be settled by the Court of Appeal.
Indeed, the only reason the health information exchange project is proceeding is the Ministry of Health is exploiting the loophole whereby the Court of Appeal allowed implementation even as final pronouncement on the constitutionality or not on some aspects of the legal framework is awaited.
The second and perhaps most formidable hurdle for the project is politics. We are in a political environment where public disdain of decision makers and scepticism is at an all-time high — where news about any mega project the government wants to implement inevitably generates angst-ridden debates, loud protests and conspiracy theories.
In a sense, some of the developments we are witnessing right now can be viewed in the context of what appears to be an increase in investment activity and engagement by Gulf-petro states in this region and especially in Kenya.
Yesterday, Reuters reported that Kenya is inching close to borrowing a whopping $1.5 billion from the Emiratis and that the interest rate will be much lower than the Eurobond of February this year. I gather the specific entity lending us the money is Abu Dhabi’s largest listed company, the International Holding Company (IHC).
In reality, the Emiratis are giving us bailout money because the inflow will be filling the gap created by delays in a disbursement we were expecting from the International Monetary Fund (IMF).
A top Treasury official told me yesterday that the borrowing is within the limit it set for commercial borrowing in the current financial year and should not be interpreted as extra borrowing. He also explained that the money from the Emiratis is not substituting what we expected from the IMF.
What is clear, however, is that the bailout money does not come without strings. Egypt, which was lent $35 billion by the Emiratis in March this year, had to allow one of the biggest land sales to an Emirati Sovereign wealth fund.
Under an IMF programme, Egypt is required to raise billions from sale of State assets. As a result, Emiratis sovereign wealth funds have been on a roll acquiring one privatised state asset after another.
Is it a mere coincidence that the Emirati company giving us bailout money, IHC, has strong links and investment relationships with the Emirati entities that want to invest in both JKIA and the health information exchange project? Sina Habari.
The writer is a former managing editor of The EastAfrican
