By Peter Oliver Ochieng

The Kisumu Solidarity Health Cover popularly known as Marwa (Ours) is up and running. The social health insurance scheme was set up by the County Government of Kisumu, with a view of providing free healthcare services to 90, 000 indigents, who could otherwise be unable to pay for medication.

Kisumu was among the four Counties alongside Nyeri, Isiolo and Machakos that implemented the pilot phase of the Government’s Universal Health Coverage (UHC) program in 2018 through to mid-2020. During registration for UHC, Kenyans in the four Counties were required to share a wide range of information; ranging from sources of income to property they own.

The 90,000 beneficiaries of the health scheme were selected from data provided during this registration after checking for various factors among them financial status and if one is employed or not. Those selected were then called and informed of the County’s offer of free medical care, in case they or their spouses and children fell sick.

As a Marwa beneficiary, one can enjoy free healthcare services in 48 facilities in Kisumu County. The facilities are ranked as Primary and Secondary. Primary are the level two and three, while Secondary are the level four, five and six health institutions. All the facilities have a data base of the beneficiaries. The beneficiary only needs to state his ID number and phone number to access services.

Ruth Owour, a poultry farmer who stays in Mowlem is among those enjoying free medical care under the Marwa scheme. She said the scheme has saved her the burden of paying for treatment, whenever she or her family members need medical attention.

“I have really benefitted from Marwa. Whenever I go for treatment, I do not pay any money from registration at the health facility, to seeing a doctor and to getting drugs,” said Owuor whose first facility of choice is the Lumumba Sub County Hospital in Kisumu.

“The first time I went to Lumumba under the Marwa cover, I had gone to seek for x-ray services. I went straight to see the doctor who told me the services I needed were not on offer at the hospital. The doctor then asked me where I could be referred to between Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) and the Kisumu County Hospital (KCRH). I chose KCRH and the referral was done electronically.”

Marwa beneficiary Ruth Owuor

Ruth adds :“I went to KCRH and because of the electronic referral, the doctor was already aware of my case. After the x-ray was done, I went back to the doctor at Lumumba for prescription of drugs. I got some but others were not available. I had to go back to KCRH again to fetch the remaining drugs. At the end of the day, the x-ray was conducted, I was given drugs and I went home a happy woman without paying a coin.”

Ordinarily, Kenya’s public hospitals charge at least Sh800 (about EUR 6.3) for x-ray services. “Marwa is seamless and has been of great help to me and my family,” added Ruth Owuor.

Eunice Adhiambo is another indigent enlisted under the Marwa health scheme. The mother of two resides in Nyalenda Estate, managing to put food on the table through sell of second hand clothes. Her business is not doing well as a result of adverse economic effects caused by the COVID-19 pandemic.

Without Marwa, she is not sure if she could be able to afford healthcare services for herself or her two kids. Sometimes back, she developed fever and headache, forcing her to visit the nearby Nyalenda Health Centre.

“I was sent to the laboratory and the malaria test came out positive. I received the relevant medication free of charge, because of the Marwa health scheme,” she said. Normally, malaria testing and treatment in public hospitals draws a bill of not less than Sh200 (about EUR 1.56). “Let the County enroll more vulnerable people,” added Adhiambo.

Marwa beneficiary Eunice Adhiambo

In October 2020, Anyang’ Nyong’o, the Kisumu Governor presented a cheque worth Sh67.5 Million (about EUR 527, 343) to the National Hospital Insurance Fund (NHIF) which is running the scheme, in a move that signaled good tidings for Kisumu residents unable to pay for quality healthcare services.

While presiding over a function to officially operationalize the scheme in March 2021, the Governor said his dream is to see Marwa succeed for the good of Kisumu residents. “Let us carefully look at the scheme’s bottle necks and confront them, so that Marwa can succeed and benefit all of us.”

According to Dr Khizra Syed who is the Head, Kisumu Solidarity Health Insurance (Marwa) Scheme, the cover focuses on funding primary healthcare and offering insurance cover for members to be able to access secondary and tertiary services in higher level facilities.

Dr Syed said the scheme is running smoothly because of its ability to get funds to insure indigents. The health cover is squarely funded by the County Government of Kisumu.

“So far, the County has enough funds up to December for payment of premiums. There have been delays from NHIF in remittance of funds but this we think are teething problems, especially since the scheme doubled the number of NHIF clients in the Kisumu office,” she said.

Dr Syed said that they are looking up to a future where all Kisumu residents willing to join the scheme will be given a nod, and in the end enjoy negotiated benefits.

“Yes, the next phase would be to allow residents to self-pay and join Marwa and enjoy negotiated benefits,”she said.

Dr Khizra Syed, Head, Kisumu Solidarity Health Insurance (Marwa) Scheme

However, the biggest challenge facing the health scheme, according to Dr Onyango Ndong’a, the Secretary General of the Kenya Medical Practitioners and Dentists’ Union (KMPDU), Nyanza Chapter is the shortages being experienced in supplies and human resource.

“The advantage that Marwa has is that it is funded. However we are still experiencing shortages in supply (drugs) and human resource. Patients are still queuing at our outpatient departments for hours and yet our hospitals’ charter say queuing should be utmost 30 minutes.  That is not a mistake of the practitioner; it is a mistake of the County,” he said.

He said he fully supports any initiative geared towards offering affordable healthcare to Kenyans.

“And by affordable I don’t mean free. By affordable I mean a sustainable way in which healthcare can be financed and also the general population benefits from such kind of arrangement,”Dr. Ndong’a said.

He urged Governor Nyong’o’s administration to strive towards offering not just healthcare to its citizenry, but quality healthcare.

“I want to laud the County for taking up Marwa. It is not a very bad idea but the way we are going to carry it out is going to determine its success. If we do not make it contributory, then we are going to fail,” he maintained.