The Refugee Dilemma: Accessing the Right to Medicare
The Refugee Dilemma: Accessing the Right to Medicare
By Lynesther Mureu and Betty Cherustui
When Kenya began hosting refugees, the numbers were minimal, and the thought was that their countries of origin, most of which were going through civil unrest, would eventually have a return to normalcy and the refugees would find their way back home. As a hospitable nation, Kenya took them in as they came, offering a home away from home, but what has become is a surging number that is now not only based in the three designated camps; Kakuma, Daadab, and Kalobeyei settlement. Kenya now hosts refugees in Urban centers and dwellings, some with permission to live within these centers while others sneak away from camps and disappear into large cities.
Kenya's Evolving Refugee Policy
The surge of numbers from time to time bring conflict with host communities and also limit service access for refugees. Additionally, the burden of hosting refugees was cost shared between government and various partners, but the shift from humanitarian to social economic development of refugees under the Shirika Plan has changed the ball game; refugees with papers are now encouraged to empower themselves and access services.
Challenges in Accessing Healthcare
*Miriam is a testament to this shift where many have to do a mindset change. Previously, her medical care was paid by the UNHCR under the defunct NHIF. Her monthly dues were credited on time and she was able to access Medicare for her multi-disciplinary neuro divergent child. Her daughter has suffered a stroke at barely two years of age, is a sickle cell carrier and now a child living with cerebral palsy. “My daughter’s condition requires multi doctors and clinic that manage each of the conditions. I have no medical cover since the shift from NHIF to SHA and have had to rely on well - wishers and partners when need arises,” states Miriam.
She resides in a one roomed house in Mombasa town with her almost teenage son. A refugee from Uganda, Miriam states her move to Kenya was owing to political upheavals that touched on her family back in the East African nation. Owing to her condition, Miriam’s daughter survives on oxygen and their tiny room hosts an oxygen concentrator donated by partners in Mombasa. She has also previously been to one of our referral hospital where they stayed for more than a year trying to manage the minor’s condition.
“ I have no steady income to accumulate resources to register for SHA, but because her condition is known in many clinics around, on occasion they are willing to treat her without payment, although that has been waning,” she states. She decries the need to have special needs desk in public hospitals in order to supply specialized care and reception. She cites, for example, how for physiotherapy for her daughter, she has to go queue with everyone yet her condition may not allow for long wait hours.
Taking care of a terminal child and being a refugee at the same time is enough vulnerability. The mental health strain, even with some counselling from time to time still takes her back home, empty handed with limited help for her daughter.
The oxygen concentrator for Miriams daughter
Navigating HIV Care as a Refugee
*Benson’s case is slightly different from Miriam’s in accessing Medicare as a refugee living in Mombasa. He is a discordant spouse, with his partner living with HIV. A refugee from Congo, Benson came to Kenya less than two years ago for him having ran away from the intensified fighting in Goma. Fending for his family was becoming a challenge thus his need to run. His wife has been unwell for over 8 years receiving her necessary dose even while in Congo. She had just arrived in Kenya this year to join her husband with their almost two year’s old daughter who is also HIV positive. When her case was first brought to the attention of KNCHR, our teams were able to intervene and assist her get the free HIV care given to patients at a local clinic. Her other three children aged 15, 7 and 4 years old have been stuck at a border point for more than three months, because they are being asked for a bribe of Sh 20,000 to have them crossed over. For now, they can only hope that the much needed stream of medication for herself and her daughter remains constant.
Benson and his wife during the interview
Challenges with the New Social Health Authority System
Even though not armed with statistics at the time of the KNCHR visit, the Social Health Authority Office in Mombasa attests that there is a decline of the number of refugees under the new system once the transition of from NHIF took place. They put the attribution to the now insurance system where one has to pay annual dues one off to access SHA medicare and the variated costs that are considered on many factors. The flat rate that was offered under NHIF, they suppose, could have worked for refugees since they are low income earners. When it comes to handling neuro diverse conditions such as Miriam’s daughter. The SHA officials mention that all the scheme takes care of the same but at government hospitals.
At the Coast General Hospital, the challenge of transitioning from NHIF to SHA lingers for special interest groups such as refugees. They refer to days where medical bills would be handled by various organizations but that seems to have dwindled over time. They from time to time find themselves waiving medical fees especially for maternity patients who are not in for long stay. “ As an institution we have set aside a small fund every fund that caters for waivers for very urgent cases and for patients who are not long stays, like the maternity wing,’ said a hospital official. Refugee are the largest beneficiaries of the kitty, with two having been waived fees of Sh 53,000 and Sh 51,000 respectively in the month on July alone.
Through the Haki na Ushirikiano Project (https://ushirikiano.knchr.org) the Commission hope that stories such as those of Miriam and Benson will continue to influence policy amendments to ensure the management of refugees encompasses the broad spectrum of human rights enjoyment in their home away from home.