CHUKA UNIVERSITY

AN TTACHMENT REPORT AT THE NATIONAL HOSPITAL INSURANCE FUND (NHIF)

CHUKA BRANCH SUBMITTED TO CHUKA UNIVERSITY FOR THE ACCOMPLISHMENT

AWARD OF BACHELOR OF ARTS (ECONOMICS AND SOCIOLOGY)

BY

NJERU MERCY WAWIRA

CB1/44213/19

ATTACHMENT PERIOD FROM 10th JANUARY TO 11th MARCH

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DECLARATION

I Njeru Mercy Wawira declare that this attachment report is my original work and has not been

presented to any institution. This report work must not be reproduced without the authors consent

or that of Chuka University.

STUDENT NAME: NJERU MERCY WAWIRA

REG NO: CB1/44213/19

SIGN………………………….

DATE…………………………

APPROVED BY THE SUPERVISOR

This attachment report has been submitted to approval of Chuka University supervisor.

NAME OF SUPERVISOR…………………………………………………..

CHUKA UNIVERSITY

SIGN…………………………..

DATE…………………………..

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DEDICATION

I dedicate this report to my colleagues at National Hospital Insurance Fund (NHIF) – Chuka

Branch, who helped me by guiding me on the various tasks that had to be accomplished, during the

entire attachment period. Thank you for all support and willingness to assist me carry out the duties

and responsibilities I was assigned. Also, to my family for been my main source of strength,

inspiration and their great support mostly financially. You were all of great importance to me

during the entire attachment period.

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ACKNOWLEDGEMENT

I would like to thank God for giving me strength and goo

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d health throughout my attachment period. His grace has always guided me in carrying out my

duties and responsibilities the entire period I of attachment. I am also grateful to Chuka University

academic staff for the knowledge and support I got from them which has made my attachment a

success. I am also grateful to the management and the rest of the staff at NHIF- Chuka Branch for

the support they gave and giving me a chance to undertake my attachment in their company. I also

extend my gratitude to various supervisors who supervised me at work, guided me and taught me

new skills. I acquired new knowledge and practical skills from them. Lastly let me thank my family

and friends for the support they gave me throughout my attachment period.

Thank you all.

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EXECUTIVE SUMMARY

Industrial attachment exercise broadens individuals mind since one is able to acquire first-hand

experience knowledge and skills in relation to the area of study and specialization. Attachés are

able to acquire practical skills related to the theory they have learnt in class, thus helps them to

become creative and innovative. It also helps in production of skilled and competent personnel.

This report gives an overview of the entire organisation I was at my attachment period that is, the

physical address, background of the company, brief history of the organisation, mission and vision,

organisation structure general activities undertaken and the challenges faced during the entire

period of attachment. It also gives a summary, conclusion and recommendations for entire.

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Contents

DECLARATION...................................................................................................................................................i
DEDICAT

vi
ION.................................................................................................................................................................. ii
ACKNOWLEDGEMENT.....................................................................................................................................iii
EXECUTIVE SUMMARY....................................................................................................................................iv
CHAPTER ONE..................................................................................................................................................1
1.0 INTRODUCTION.....................................................................................................................................1
1.1 ORGANIZATIONAL PROFILE...................................................................................................................1
1.1.1 PHYSICAL ADDRESS.........................................................................................................................1
1.5 OBJECTIVES............................................................................................................................................2
CHAPTER TWO.................................................................................................................................................4
2.0 ORGANIZATIONAL STRUCTURE..............................................................................................................4
2.1 POLICIES AND OTHER ORGANISATION LINKS.........................................................................................7
2.1.0 Membership information.............................................................................................................7
2.2HOW NHIF FIT KENYA VISION 2030........................................................................................................8
CHAPTER THREE............................................................................................................................................10
3.0 ORGANIZATION DEPARTMENTS..........................................................................................................10
3.1 Registration department.....................................................................................................................10
3.2 Operation Department........................................................................................................................10
3.3 Benefits Department...........................................................................................................................10
3.4Accounting department........................................................................................................................11
3.5 Audit Department................................................................................................................................11
4.0 CHAPTER FOUR........................................................................................................................................12
4.1 SPECIFIC ACTIVITIES UNDERTAKEN DURING INDUSTRIAL ATTACHEMENT..........................................12
4.1.1 Registration department..............................................................................................................12
4.1.2 Benefit department......................................................................................................................12
4.1.3 Accounting department................................................................................................................13
4.1.4 Auditing department....................................................................................................................13
4.2 SKILLS AND KNOWLEDGE APPLIED FOR THE BENEFIT OF THE ORGANIZATION...................................15
How I will utilize contacts gained..............................................................................................................16
4.3 Analysis, Observations and Critiques...................................................................................................16
5.0 CHAPTER FIVE..........................................................................................................................................18
SUMMARY, CONCLUSION AND RECOMMENDATION................................................................................18
5.1Summary..............................................................................................................................................18
5.2Conclusion............................................................................................................................................18

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 5.3Recommendation.................................................................................................................................19

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 CHAPTER ONE

1.0 INTRODUCTION
This report provides a summary of the industrial attachment carried out at the National Hospital

Insurance Fund (NHIF) –Chuka Branch. The report also highlights the work done, the experience

gained, and the recommendations to the Establishment department.

The purpose of this industrial attachment exercise is to enable us as students to put into use the

skills learnt in class into field practice and gain more skills from the field of work and also

familiarize with the outside work environment.

During the attachment period all the sub county employees were required to report to work as from

8am to 5pm during the week days. All weekends and public holidays we were not supposed to

report to work. All work was executed according to the directions given by the supervisor and other

skills learnt in class.

1.1 ORGANIZATIONAL PROFILE

1.1.1 PHYSICAL ADDRESS
The NHIF Chuka Branch is located in Chuka town along J.N BUNDI Plaza opposite KPLC

Offices.

The postal address of NHIF Chuka Branch offices is P.O Box 414-60400, Chuka.

The email address of NHIF Chuka Branch office is nhif@chuka.or.ke.

The telephone contact of NHIF Chuka Branch office in Kenya is 0771263765.

1.2 HISTORICAL BACKGROUND

The NHIF was established in 1966 under Cap 255 of the Laws of Kenya to be run by an Advisory

Council appointed by the Ministry of Health. It catered for salaried employees earning Ksh.1, 000

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and above per month, making a monthly contribution of Ksh.20 per month. In 1972 an amendment

was made to incorporate the voluntary members and self-employed members at a monthly

contribution of Ksh.60. In 1998, Cap 255 was repealed and replaced by the NHIF Act No. 9 of

1998 which transformed the Fund to a state Corporation managed by an all-inclusive Board

representing various stakeholders and interested groups.

The transformation of NHIF from a department of the Ministry of Health to a state of corporation

was aimed at improving effectiveness and efficiency. The Fund's core mandate is to provide

medical insurance cover to all its members and their declared dependants (spouse and children).

The NHIF membership is open to all Kenyans who have attained the age of 18 years and above.

NHIF has 93 fully autonomous branches across the country. Each of these branches offers all NHIF

services including payment of benefits to hospitals or members or employers. Smaller satellite

offices and service points in district hospitals also serve these branches.

For the past 50 years, NHIF has been committed to provide accessible, affordable, sustainable and

quality healthcare to its members with the aim of improving the social welfare and productivity of

the nation. Therefore, it assists the health sector towards the realization of the Millennium

Development goals and vision 2030 through improving the healthcare situations in Kenya.

1.3 VISION

To be a world class social health insurance scheme of choice in the Sub-Saharan region regarding

sustainability and quality of service.

1.4 MISSION
To provide accessible, affordable, sustainable and quality social health insurance through effective

and efficient utilization of resources to the satisfaction of stakeholders.

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1.5 OBJECTIVES
1) To effectively and efficiently register members, collect contributions and pay out benefits.

2) To enhance the Fund’s quality management system.

3) To prudently manage resources.

4) To develop and maintain strong customer relationships.

5) To develop and retain relevant competencies.

1.6 MAIN FUNCTIONS OF NHIF

The Fund's core mandate is to provide medical insurance cover to all its members and their

declared dependents (spouse and children) and the execution of this mandate is achieved through:-

1) To effectively and efficiently register members, collect contributions and pay out benefits.

2) To regulate the contributions payable to the Fund and the benefits and other payments to be

made out of the Fund.

3) To enhance and ensure adherence and conformity to international standards in quality service

delivery.

4) To ensure prudent management of resources.

5) To contract service providers and provide access to health services.

6) To protect the interests of contributors to the Fund.

7) To advise on the national policy concerning the national health insurance and implement all

Government policies.

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 CHAPTER TWO

2.0 ORGANIZATIONAL STRUCTURE

NHIF is run by a board of 14 directors comprised of representatives drawn from all key

stakeholders and is charged with policy formulation and decision making on all policy matters.

Also, a senior management team comprising of professionals works with their staff to address the

needs of all their clients and provide strategic planning for the Fund's future goals. NHIF is

managed by an all-inclusive Board of Directors representing various stakeholders and interested

groups namely:

1) Ministry of Health.

2) National Treasury.

3) Ministry of Devolution and Planning.

4) COTU.

5) Directorate of Public Service Management.

6) The Kenya National Union of Teachers.

7) Director of Medical Services.

8) Kenya National Farmers Union.

9) Federation of Kenya Employers.

10) Association of Kenya Insurers.

11) Christians Association of Kenya.

12) National Council of NGOs

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13) Kenya Medical Association.

14) Director of State Corporation

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The following Chart is the Management Structure of NHIF

BOARD OF DIRECTORS

CHIEF EXECUTIVE OFFICER

GENERAL MANAGERS

DIVISIONAL MANAGERS BRANCH MANAGERS

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2.1 POLICIES AND OTHER ORGANISATION LINKS
2.1.0 Membership information
There is no upper age limit in membership to NHIF. The retirees can also continue with their NHIF

membership by changing to voluntary membership. There are three main categories of membership

to NHIF.

1) Statutory Membership.

It is a compulsory membership for all the employed persons earning a total (gross) monthly

income of at least Ksh.1, 000. They make monthly contribution ranging from KSh.150 to Ksh1,

700 base on the gross monthly income. Employers effect deductions and remit online through

NHIF bank accounts at KCB, Cooperative Bank and National Bank of Kenya or Equity Bank.

Before submitting the monthly deductions to NHIF, the employer should upload online payroll

by-product detailing all the employees in the NHIF prescribed format and generate an E-Slip or

By-product number.

2) Self-employed membership

These are the unemployed persons willing to become contributors to NHIF. They contribute

Ksh.500 per month which can be paid upfront either quarterly, semi-annually or annually

depending on the member ability to remit the premium payable. They make their payment through

Mpesa but can also deposit their contribution to NHIF bank accounts at Kenya Commercial Bank,

Cooperative Bank, National Bank of Kenya, Family Bank of Kenya or Equity Bank.

3) Sponsored Programmes Membership.

This covers mainly Orphaned and Vulnerable Children (OVC). They contribute Ksh.500 per three

children and the contribution should be paid for at least one year upfront. Each child is issued with
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an NHIF card and since they are under 18 years and have no ID numbers, they are issued with

special numbers in place of ID numbers. This cover is also for indigents (the vulnerable groups or

families) who are supposed to make a monthly contribution of Ksh.500 per family.

2.2 HOW NHIF FIT KENYA VISION 2030

The aim of Kenya Vision 2030 is to create “a globally competitive and prosperous country with a

high quality of life by 2030”. It aims to transform Kenya into “a newly-industrialising, middle

income country providing a high quality of life to all its citizens in a clean and secure

environment". To attain this, the government has come up with various development projects ‘The

Big Four Agendas’ (food security, affordable housing, manufacturing, and affordable healthcare

for all.)

Various parastatals and other supporting agencies have therefore been developed to foster, initiate,

regulate and implement the agenda. With National Hospital Insurance Fund being among the

pinnacle of the realization of healthcare for all agenda it has come up with projects and activities to

this effect as follows:

1. Benefit Package

The Fund has continued to review benefit packages to members. New packages have been

introduced after the review of monthly contribution rates. The current benefit packages are:

Outpatient; Inpatient; Maternity Package; Renal Dialysis; Kidney Transplant; Radiology

Package( MRI&CT Scan); Oncology Package (Cancer treatment – chemotherapy & Radiotherapy);

Rehabilitation, Drug and Substance Abuse Package; Foreign Treatment package; Chronic Diseases

(diabetes& Hypertension); Specialized Lab Tests; and Surgical Package (Minor, Major &

Specialist).

2. Declaration and Contracting of new Healthcare Providers.

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In an effort to speed up the declaration and contracting process of new healthcare providers (hcp)

into the NHIF system, the fund suspended pre-assessment audits and accreditation fees. The

healthcare providers applying for declaration now only need to fill an application form, attach their

hospital registration papers and licenses from relevant government bodies authorizing their

operations.

3. Internal Restructuring for improved service delivery

Towards embracing a competitive business culture and practices, the fund put in place a new

organization structure comprising four directorates, two heads of department and six regional

offices to ensure proper coordination of all NHIF service points spread across all the 47 counties.

The reorganization has seen creation of divisions of Communications & Public Education, and

Marketing and Customer Service to address the issues of corporate communications, customer

service, the Fund’s corporate image and continuous public education on NHIF programmes.

4. Computerization and Decentralization

NHIF operations have been computerized and decentralized, enhancing efficiency in settling

claims and effective management of membership database. The Fund also increased its service

accessibility through the current networked 63 fully-fledged branches, 35 satellite offices and

service points at most district hospitals countrywide. The branches function independently to offer

services similar to any other office across the country.

5. Cost Containment

The Fund operates a zero-based budget allowing A-I-E Holders to spend within the planned

budget. This has enabled administrative costs to be reduced and enhanced line A-I-E Holders

accountability.

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CHAPTER THREE

3.0 ORGANIZATION DEPARTMENTS

3.1 Registration department
This section is responsible for registration of members. The membership is open to all persons

regardless of age or gender. NHIF registers all eligible members from both the formal and informal

sector. For those in the formal sector, it is compulsory to be a member. For those in the informal

sector and retirees, membership is open and voluntary. To register with NHIF as a member or an

employer or organized group, one fills in the relevant Registration Form. The members registered

and entitled to the NHIF cover should: -

1) Be residents of Kenya

2) Have attained the age of 18 years and above.

3) Have total monthly income of not less than Ksh.1, 000 whether derived from employment or

self-employed.

3.2 Operation Department

The department involves a range of activities undertaken in serving the members. The NHIF is

committed to offering the best of their service to their royal customers. The operation department

deals with the member management. All the data concerning the member and/ or the employer are

captured into the system and stored in a centralized database for quick and easy access.

3.3 Benefits Department

Since inception, NHIF has been offering largely in-patient benefits but has recently extended the

package to provide the Outpatient benefits. NHIF covers the contributor, declared spouse and

declared children. Children over 18 years of age can benefit from their parents’ contribution if they

are in full-time school or college or in case they are mentally or physically handicapped in such a

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way they wholly depend on their parents. When accessing the benefits for such a case, a letter from

the school/ college or medical report respectively must be produced to prove that.

Self-employed or Voluntary contributors who enrol as individuals qualify for benefits after 60 days

from registration date while those who register through organized groups and Sponsored

Programmes qualify after 30 days from registration date. The NHIF members are entitled to access

quality health services from any accredited medical facilities countrywide for the premium paid to

the Fund. NHIF is obliged to make some payments to the hospitals ones the member or his/ her

dependants seek medical attention from the accredited medical facilities. The claims are sent from

the hospitals to the NHIF office, where they are received, captured, checked and payment is made.

The NHIF verifies whether the claims made are justified and correct. The duration which the

claims received from the hospitals are processed is usually within 14 days.

3.4Accounting department
In the accounts unit this is where all financial transactions takes place. First there is raising of

payment vouchers. This is a process where you check member’s contribution payment due to

defaulting cases. Then there is printing of payments vouchers. It is then followed by transferring

and posting the vouchers to accounts payable.

In accounts departments there is collection of data to analyse how money paid under capitation to

various facilities is being utilized.

3.5 Audit Department

The Audit Department is the last stage where the Hospital Claims are thoroughly checked and

approved to ensure there is no error made on the claims just about to be settled. There might be an

unnoticed error that may have passed all the other previous stages unrealized. In case of such an

instance the claim is taken back to the right stage and rectified before is fully processed for

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settlement. If incorrect information is given in the claim document the payment for the claim

cannot be processed and is taken back to the hospital for correction.

4.0 CHAPTER FOUR

4.1 SPECIFIC ACTIVITIES UNDERTAKEN DURING INDUSTRIAL ATTACHEMENT

4.1.1 Registration department
The following are the main duties and tasks I was assigned to: -

1) Registration of new members.

2) Capture of the new members’ spouse and children into the system.

3) Scanning, merging, and printing cards and photo card dispatch.

4) Filing of the members’ forms into the system and later stored in files for quick and easy access

while needed.

5) Customer care services and procedures.

4.1.2 Benefit department

The following were the main activities I was exposed to: -

1) Receiving claimants, conducting initial assessment and offering advice on procedural

requirements to duly filled claim forms.

2) Receiving claims from hospitals and ensuring they have relevant documentation.

3) Capturing the data into the system which involves: - a) Receiving the claims in the system.

b) Accepting and authorizing the received hospital claims to proceed with the payment process.

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c) Check the data captured into the system to verify whether it tallies with the information

contained in the claim form.

4) Responding to general telephone enquiries about the claim payment procedure.

5) Assessment checklist for Accreditation of health facilities using excel. This entails: -

a) Capturing questionnaire data into the system for analysis and decision making.

b) Preparing summary reports on proposals for evaluation.

c) Submit the result to the Senior Benefits Officer for approval.

4.1.3 Accounting department

The following are the main duties I was subjected to during the period I was attached at the

accounts department.

1) Check of the claims and approving them for payment to be settled.

2) Verifying and validating that the data captured in the system and the information provided in

the claim form tallies.

3) Verify that the claim document has all the relevant supportive documents required for the claim

to be processed. All the claims presented from the hospitals should have the ID card of the member

and the patient’s ID card for a spouse or a birth certificate in case of a child less than 18 years.

4) Check and verify that the member’s premium payment is up to date and is fully covered by

NHIF. This involves verifying that the member has not defaulted the monthly premium payment

and/ or the penalty is paid for late monthly upload before the claim is paid.

5) Printing of invoice cheque for the fully processed hospital claim for payment to be settled.

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4.1.4 Auditing department
The following are the duties I was assigned: -

1) Verify that the information given in the claim document coincides with the data captured in the

system.

2) Ensure that the total rebate amount claimed by the hospital is the same approved for payment

by NHIF.

3) Ensure that claim document has all the required and correct information about the claimant and

the hospital where the patient was treated.

4) Approval of the duly checked claims for payment.

5) Ensure that the member has fully paid the monthly premiums without defaulting or late

payment. Any late premium paid attracts some penalty. Therefore, the unpaid premiums plus the

penalty charged must fast be paid otherwise the claim is rejected.

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4.2 SKILLS AND KNOWLEDGE APPLIED FOR THE BENEFIT OF THE
ORGANIZATION
1) Analytical decision making.

In an active business environment, making decisions is part of the daily routine not recorded

anywhere. Versed with the modern managerial science skills, it was an advantage analysing

situations and making the decisions that promoted serving customers with clarity.

2) Excellent communication skills.

Departments within the organization rely on information from one another. I was subjected to

deliver important messages to the officers in other departments. I possessed good communication,

both orally and written and therefore I delivered right and correct information relevant for effective

running of the organization.

3) Leadership skills.

I demonstrate good leadership skills and competencies which helped smooth and fast performance

of the assigned duties. I stood out as an outstanding leader by engaging in training other attaches

through the undertaking of the tasks assigned together.

4) Accuracy and efficiency.

Accuracy and efficiency were important tools in every department I was attached. I ensured all the

data captured in the system were correct and timely as required by my supervisor. It was never a

challenge to me as this is something I have developed throughout my studies and I perfectly met

the organization expectations.

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How I will utilize contacts gained

In the course of the attachment placement period, I was able to interact with various officers and

staff members whereby I developed essential contacts that will be helpful even after completion of

my attachment. Additionally, I gained considerable experience that will boost my CV for the

interest of potential employers and NHIF is an equal opportunity provider. The supervisors and

field officers will form a reliable team of referees for my future job searches. The skills acquired in

the firm will play an important role in shaping my career and approaches to work.

4.3 Analysis, Observations and Critiques

1) System failure.

Sometimes customer stayed long and others went unattended when the system failed. The system

failure attracted complains from the clients for taking a long time waiting for services. The system

failure had been brought by an upgrade of the whole system inter-connection, but the problem was

fixed with time and things run as usual.

2) Slow system and computers.

Slow system and computer sometimes could create long queues when customers flocked in seeking

services. Some of the computers used were old and slow whereby they hung and gave a slow

response to the command given. The NHIF system is interconnected via an internet connection.

Despite the fact there are many operations at NHIF are computerized and relying on the network,

the connection is slow and thus reducing the efficiency. Time is wasted waiting while requests are

being processed.

3) Choice of outpatient medical facilities.

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Wrongful capture of some members’ choice of outpatient medical facility. Some members came

with complaints after attending their preferred hospitals that they were given the wrong choice of

their outpatient medical facility. Short duration given for the change of the medical facility seemed

inadequate for many members had not changed to their preferred choice at the date of closure.

4) Mobile Money

To facilitate timely remittance of member contributions and maintenance of up to date payment

information for individual accounts, NHIF has partnered with Safaricom to provide a flexible and

convenient platform for remittance of monthly insurance premium contributions from informal

sector populations. There were challenges and delays in integrating the Mpesa payment platform

with the NHIF payment and information technology system. Some beneficiaries would arrive at

health facilities to learn that they could not access services because contributions were not being

reflected in membership accounts promptly.

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5.0CHAPTERFIVE

SUMMARY, CONCLUSION AND RECOMMENDATION.

5.1Summary
Industrial attachment is very important to a student in any field of study as it enables him or her

to apply the skills learned in class to real-life work experience. During my entire duration of

attachment at NHIF Chuka Branch, it was a wonderful experience versed with a diverse area of

scope. It is an excellent way to interact with other officers in various capacities and it further

equipped me with various skills, for instance, good interpersonal relations, upholding the spirit of

teamwork and gaining core competencies in my area of study. All the roles and responsibilities

that were assigned to me during the attachment period were relevant to my area of study. The

whole experience was educative and from what I learned and the skills acquired, I know I can

confidently face the job market.

5.2 Conclusion
NHIF has a highly computerized and decentralized system, which it employs in all operations of

the organization and thus aiding in efficient delivery of services. While serving the clients, the

system is protected from unauthorized access and I thank all those who gave me the opportunity,

supervision, authorized their login and the guidance they offered. Having served in four

departments with all my devotion and commitment saw me through a fruitful period.

Indeed, the attachment programme has been a vital experience mainly because it has helped me

acquire a variety of skills and competencies and I appreciate. Facing different challenges during

my service was also good as I could come up with solutions and at times I had to make

individual decisions. I could translate the knowledge accumulated in class to the real world

situation and successfully solve all the problems I encountered.

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5.3Recommendation
From the analysis and observations, I made during the attachment period, I would like to

recommend the following to the NHIF management.

1) Constantly check the system to ensure effectiveness and efficiency. In case there is system

upgrade, there should be proper communication to all stakeholders notifying them of the changes

being undertaken. The right measures should be set in place to ensure that daily operations are

not affected by system changes.

2) Computer servicing and maintenance should constantly be done to solve the problem of slow

system and computers. Also, the management should deploy an IT technician at the Branch level

who can be fixing most of the internet connection problems and system maintenance.

3) The duration of the change of outpatient medical facility should be adequate and effectively

communicated and ensure all members are aware.

4) The members should refrain use of mobile money when an immediate update of the payment

made is required and use the alternative payment via the bank accounts. NHIF should collaborate

with Safaricom agency and ensure the delay problem is fixed and also it should take good

consideration in future when introducing new payment platforms.

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