There has been a felt need for medical insurance at the University of Nairobi since the late 1990s. The capacity of the University Health Services (UHS) to provide needed services gradually weakened in tandem with increasing staff numbers (plus the more rapidly growing number of dependents) and declining capitation by the national government. As it did so, the need for an insurance scheme grew. And yet everyone was stuck in the mindset that any enhancement of service delivery and related cover must be employer-driven. Staff who could afford additional services on their own did so, of course, but they were few and far between. Dons waited for the employer to do something, even as many were blinded or distracted by the prospects of Module II pay. The employer, it increasingly seemed, waited for providence to show its hand.
Fast-forward to March 2017. With the signing of a pay deal between the National Office of the University Academic Staff Unions (UASU) and the association of university employers, everything suddenly changed. Conversations about a medical insurance scheme fully funded by academic staff themselves began in earnest, spurred by pent-up frustrations with the status quo, and perhaps also by the prospects of a more responsive remuneration regime.
What follows below is essentially an abbreviated transcript of the conversations that University of Nairobi dons have been having lately. This had actually started in the last days of a WhatsApp group called Lecturers' Strike. The group's essential purpose had been to keep UASU members posted on the twists and turns of the pay negotiations sparked-off by a national strike declared in January 2017.
When a deal was struck and the strike called off on March 13th, those who had signed on to that WhatsApp group left in droves, as if running away from something; as if fear was not the only thing one had to fear. But not before the need to continue with discussions already started about two topics was emphasized: a new sacco and don-driven medical insurance.
While some shifted to a national idea dubbed Mhadhiri, a more focused WhatsApp group called UoN Medical Insurance Group was formed on March 16, 2017. A total of 86 academic staff had joined the group by early morning of March 21st, but on different dates. Those who joined days after the discursive engagement had begun have asked for a better way to bring them (themselves) up to speed, than simply asking them to scrawl up and down the comments on the old group page. After all, going back to the Lecturers' Strike sounded like going to an abandoned 'dwelling' in the dark, where malevolence might prowl -- unseen. Hadn't brave folks just dashed out of the now desolate place?
We have toyed with two options: 1) to periodically insert the earliest texts in the continuing conversation for the benefit of relative newcomers; and, 2) to shift older texts to an online platform in order to obviate looped and entangling insertions. What you find on this blog post is option 2. Not all that was said is shown here. So these are excerpts, arranged in chronological order.
TRANSCRIPT OF OLDER CONVERSATIONS
March 13, 2017:
P.O. (2:33 PM): Strike over!
V. (2:52 PM): Kindly attend a members' meeting today at 4 pm in Senior Common Room on the 2013-2017 CBA.
M.K. (4:43 PM): Mhadhiri Sacco, join by following the link below. So far it appears uon is missing out.
M.U. (5:02-5:04 PM): 1. I fully support the Mhadhiri Sacco. We need it urgently. However, could we reflect on the formal process of establishing it?... The NO of UASU should be challenged to pick up this matter...
R.O. (5:18 PM): I don't understand background to this drive? Is Chuna no longer serving our sacco interests?
P.C. (5:21 PM): Which chuna? Have you seen the dividend it gives? A sacco associated with the employer is not always the best...
R.O. (5:27 PM): To a large extent dons have been quite aloof on Chuna issues - will they be more engaged with mhadhiri?
M.Y. (5:33 PM): I honestly think that launching a group health insurance to enhance health cover well above what the University offers would be more protective of everyone's future than any sacco, regardless of who will be at the helm. Of course I am assuming that the law permits such cover to supplement the existing one. As for a new sacco, I bet it will collapse before 2021...
M.U. (5:35 PM): The Mhadhiri Sacco can also pick the insurance cover for us as a complimentary benefit.
Anon (5:40 PM): Will finance remit contributions since they don't to external saccos?
R.O. (5:42 PM): My thought is lets clean up our Chuna!
P.C. (5:42 PM): These days one can use other avenues including Mpesa and bank orders. If we use finance on this, what happens when it delays remittances?
J.M. (5:53 PM): Let us start our own sacco and organize ourselves to augment our health insurance cover. The two could be somehow tied together...
M.Y. (9:10 PM): We tried to launch a FoA sacco [in 1999-2000] but didn't make any headway. We encountered resistance from Chuna and its support structure from the highest level at UoN and in the coop movement. We were determined but the resistance was huge...
M.M. (9:17 PM): I think that was then, Now we can do it. Prblm is we're good at eating instins, not growing them...
L.K. (10:32 PM): I thot this [sacco] idea is already being discussed on another platform that we were referred to... How many mhadhiri saccos will we have surely???
J.M (10:40 PM): Agree. Those interested in sacco can join the telegram forum provided.
March 14th:
K.K (7:37 AM): If you join a SACCO whose membership comprises [Dons] from these new universities, you will be in trouble...
T.M (9:41 AM): This lefting is reminiscent of another WhatsApp group I had been added to plan a wedding. I forgot to leave after the event until I was eventually removed long after the marriage had...
R.O. (9:44 AM): Interesting to 'watch' the Exodus! I think academics should be able to disagree amicably without disengaging.
K.O. (9:54 AM): Let us respect people's right to choose either to to leave or stay in the platform. Lefting is perfectly okay just as...
M.Y. (9:59 AM): I support the idea of a parallel Medical Scheme, but built into it must be some form of group insurance to protect us and our dependents adequately against serious emergencies -- short term or long term. Right now we are totally exposed to such dangers.
Back to saccos. One must decide if a new well-run sacco is desirable because of the services it can deliver, or if we just want one of our own because we don't want to mix it up with the 'others' at meetings. The first sentiment is wholesome and perhaps even holy. The second is simply doomed to failure for various reasons -- besides its snootiness...
M.U (10:15 PM): Am from UoN whwrw I go to the university clinic. But I think it is high time that we get an insurance cover than hii university clinic. KNUT has partmer with AON Insurance and teachers can jump to any hospital and be treated. They have a 700k for just outpatient.
R.O. (10:24 PM): I think this falls under the internal CBA for the UoN UASU chapter.
M. (10:45 PM): The medical insurance cover is a priority area... we need to translate this idea into action...We can trust Colleagues with insurance expertise to provide guidance and help us shop for a stable insurance company.
March 15:
M.Y. (12:00 AM): Grateful for the comments I have read on the proposed parallel medical cover. How do I think we should fund it? By pushing a resolution to allocate right from the Salaries Office 50% of the amount we have been remitting to UASU on a monthly basis. That will probably generate KES 2,500,000 per month and 30m per year from UoN Dons alone, assuming there are 2,000 of us and that those not in UASU agree to join the parallel scheme.
The debits should go directly to an account managed by Trustees elected by contributors and independent of both UASU and varsity management.
We can start this at UoN before we go national.
I think that service providers and intermediaries such as AAR, UAP, AON, Britam and the big hospitals will go gaga over this.
M.U. (12:44 AM): It will be much cheaper running such a scheme than even the UHS.
J.A. (6:45-6:46 AM): I fully support. Critical mass of interested persons required to move forward. Can we have advice on the nit grits please. This way we will cushion ourselves and those we represent during lean and difficult times.
Anon (6:47 AM): Every government employee is entitled to a medical allowance. We do not get this and it should be channelled to the scheme as opposed to the clinic [which] some of us cannot access because it does not make any economic sense to incur transport costs just to be referred to other hospitals.
Anon (8:20 AM): I also believe in the investment part. This could as well be a solution to the sacco proposal touted earlier in the forum. UASU investment group.
M.Y. (9:12 AM; 10:26 AM): An investment group is a great idea too. The stronger it gets, the greater the voice it will give Dons in the national economy and beyond. nd it can grow very quickly if prudently managed. Much more innovative than the conventional sacco idea.
Any Investment Group we launch must be independent of both University management and UASU. UoN Dons are perfectly capable of launching an Institution-based Investment Group.
Anon (10:29 AM): It is a better fit compared to a sacco.
M.Y. (10:46 AM): UASU is our political arm. It shouldn't scheme to hog all other aspects of our lives. Imagine Jubilee or NASA trying to seize all their members' initiatives.
O.W. (12:00 PM): Yes, these are some of the issues that we need to follow up on immediately lest we forget that there are many other issues touching on our welfare that need to be given as equal attention as remuneration!
R.O. (12:09 PM): Many interesting ideas are being floated by colleagues. It will be important to focus on a few with resolute determination to see them come to fruition. I also think it is dangerous to destroy UHS: our employer committed himself to providing high-quality health services, and we should hold him to account concerning this. This, of course, does not preclude an insurance scheme, which is a very good idea. Again, I think that if we pursue all these things simultaneously, we shall spread ourselves too thin. Let us identify one or two lines to pursuewith vigour, get them going, and then take up more.
E.A. (12:11 PM): Best suggestion R.O.
R.O. (12:20 PM): Thanks a lot, E.A! I suggest that we rename this group to reflect its vision beyond the strike.
J.M. (12:27 PM): Good idea
M. (1:02 PM): No doubt UHS @uon are doing their best under the prevailing circumstances. However, I still support an independent insurance cover which will cover dental and optical issues without a minimum refund requirement. It can be very distressing when families have to decide who gets their root canals before the other because of shortage of funds.
M.U. (2:10 PM): The entire UHS needs overhaul. We need an upgrade to to a fully fledged teaching and referral hospital. Meantime, a good insurance cover is urgent. It will save us the blushes and hassles of admission and discharge from hospitals.
M.N (2:16 PM): The VC was looking for avenues to generate income for UoN. Starting a world class hospital to rival Aga Khan and the rest is worth trying. The land in perfect location is there, the staff are abundant and the patients are in their millions. Kazi kwetu.
M.U. (2:16 PM): Tiny parastatals like the Tourism Fund, Kevevapi, Kemri etc have excellent medical covers for staff. Why are we stuck in this stone age?
M.U. (1218 PM): They have been talking about this [World Class Hospital] issue for over a decade. Where are we? KU came from behind, they are almost done with their referral hospital...
R.O. (2:23 PM): I agree that the insurance scheme is most urgent because it would take a while to get a referral hospital.
M.M. (3:04 PM): If the list of interim officials of proposed mhadhiri sacco is genuine, it luks like another plot 2 sideline uon (remember uasu no). If that is the case, the idea is A DEAD DUCK!
K. (3:07 PM): Saw this too. No way I can continue to present myself for other deliberately marginalizing outfits. No way.
L.O. (3:29 PM): I support the dual approach. As we plan for the insurance cover the Union should see how services at UHS can be improved.
M.M. (3:47 PM): We must invent a formula of dstrbtng elective posts in all our outfits 2 reflect theface of Kenya. We're in the era of devolution, human rights including women and ppl with disabilities.
P.C. (4:45 PM): I think it's better to air these sentiments at the Mhadhiri Sacco forum, this is the wrong forum for this
M.Y. (5:27 PM): How many people do we still have in this Lecturers' Strike Forum? If it is the wrong forum, can someone offer to launch a new one for those of us interested in the Medical Insurance idea and who think that a sacco, Mhadhiri or otherwise, would not be the right base for it? We need to have a meeting of UoN Dons about Med Insurance in the next two or so weeks.
O.W. (5:32 PM): The medical insurance meeting, yes I support! But also think that UASU UoN chapter should convene a quick meeting so that we agree on the agenda for 2017. We can then present to them ...a checklist of all the issues we want them to pursue next
M.Y. (5:40 PM): That's fine too. We need to have a conversation at UoN with with our UASU UoN leadership. But those who will run the scheme must be an independent board with its own mandate and account. Yes, let's meet, but not as SCR, perhaps one of the big rooms at The Tower.
M.U. (5:46-5:47 PM): I am in full support. Admin, could you please create a separate forum to address the issues M.Y is raising. I will be a member of the group.
M.U. (6:25 PM): Admin kazi kwako.
March 16:
The The UoN Medical Insurance Group was launched on WhatsApp.
Admin (11:50 AM): Any UoN Don interested in this conversation is free to join.
A total of 13 Dons registered on the first day, Dr. Agaya being the first.
R.O. (8:03 PM): Thanks...for adding me to this group! Let us pursue this matter with determination, focus and effective strategy.
M.U. (8:08 PM): Thanks for adding me to the list. A great step in the right direction.
J.M. (8:15 PM): Thank... and support sentiments of my colleagues above.
**End of transcript available from the Lecturers' Strike Forum, just as exodus from the Forum picks up speed**
March 17th:
M. (4:22 AM): Thanks for the add. Ni ya Nini lakini?
Admin (4:54 AM): Dr..., you were [on] a list I was given to include in this WhatsApp Group. The group is dedicated to building a consensus around a much needed UoN Medical Insurance Scheme. This should help Dons fill the current gap in UHS service delivery, particularly with regard to major emergencies, which Dons have frequently encountered.
The problem is essentially financial, and the driving idea is how to leverage our collective purchasing power in order to source adequate medical cover during emergency admissions and fairly extended hospitalization or specialized care of contributing members.
Admin (5:33 AM): I should also add that Dons wish to have the flexibility which a medical card gives in terms of where one can go for checkups or medication in lesser emergencies, and when travelling or on leave.
We shouldn't be tied to just one clinic, or tied down by regulations entailing written and time-consuming pre-approval for every visit to a doctor. But certainly, every card will impose limits on how much can be spent over a set period of time.
M.U. (8:28 AM): ...And some medical covers are exceptionally good, some have very good complementary benefits. As dons, we have numerical advantage which ordinarily attracts better packages.
J.A. (8:41 AM): I can't agree more...We need serious advice on how to move forward with speed.
M. (9:19 AM): Let's be cautious... Inasmuch as insurance cards have flexibility, they have limits say kshs. 1 million for inpatient. This has to be borne in mind. Current arrangement can be strengthened...My thoughts.
M.U. (9:24 AM): The red tape and hassle at UHS when you need admission is painful. UHS has no flexibility if you [reside] far away from town. I think this initiative is [complementary] to what we have. Lastly, reforms have hardly been implemented at the UHS in spite of the many efforts.
Admin (9:22 AM): Good thoughts. We must maximize the possibilities of our collective effort. As the conversation proceeds, we'll begin to pin down details and specifics and consider various optimization options. I think at some point we will invite one or two experts in medical insurance to give us a talk. Our own home-grown Actuarial Scientists will be asked to share their calculations.
J.A. (9: 30 AM): Let us move forward carefully leveraging on available expertise from within and without... It is a matter of getting value for money... Medical costs can bring even the very richest to zero ground in a matter of days.
M. (9:34 AM): Thanks doc. We can explore possibilities of pressing for reforms at UHS. Let's make wide consultations, as suggested, for informed choices.
J.A. (9:42 AM): How do we [reform] UHS when one cant [get] even basic medication. Remember University managers are well taken care of and so they really don't care about what goes on at the health facility... Recall what happened with education for dependants? Immediately the managers were through with educating theirs everything literally collapsed... At JKUAT the education waiver for staff children is 80% unless it has changed recently.
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NOTICE is hereby duly served of the First General Meeting of the Founding Members of the UoN Medical Insurance Group, to be held in 8-4-4 Hall (MPH), on Main Campus, UoN, from 2 to 5 pm on Sunday, April 9, 2017.
AGENDA
1. Meeting called to order, followed by prayer(s).
2. Introductory remarks by Prof. Yambo: How we got here and where we're headed.
3. Self-introductions by Founding Members.
4. Official Naming of Medical Insurance Group.
5. Determining the Group's core function(s) and outlining its Memorandum and Articles of Association. Steps to registration.
6. Election of seven Trustees or Directors to the Board, with positions for Executive Chairperson, Secretary, Finance, Medical, Legal and Board Member (all subject to variation at the general meeting).
7. Determining the parameters of Group health insurance needs.
8. General discussion: How to identify and procure the services of a credible medical insurer.
9. Launch of the Register of Group Members. Setting of Membership fee.
10. Scheduling of presentations by prospective insurers.
11. AOB.
12. Closing of meeting. Prayers. Photos.
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AGENDA
1. Meeting called to order, followed by prayer(s).
2. Introductory remarks by Prof. Yambo: How we got here and where we're headed.
3. Self-introductions by Founding Members.
4. Official Naming of Medical Insurance Group.
5. Determining the Group's core function(s) and outlining its Memorandum and Articles of Association. Steps to registration.
6. Election of seven Trustees or Directors to the Board, with positions for Executive Chairperson, Secretary, Finance, Medical, Legal and Board Member (all subject to variation at the general meeting).
7. Determining the parameters of Group health insurance needs.
8. General discussion: How to identify and procure the services of a credible medical insurer.
9. Launch of the Register of Group Members. Setting of Membership fee.
10. Scheduling of presentations by prospective insurers.
11. AOB.
12. Closing of meeting. Prayers. Photos.
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UPDATED: March 22, 2017 (9:38 AM and 9:36 PM); March 23 (8:06 AM); March 27, 2017 (10:21 PM); April 6, 2017 (7:26 PM); April 28, 2017 (10:40 PM); May 11, 2017 (6:15 PM); May 17, 2017 (2:25 PM). [To be continued. Meanwhile, any group member with objections to this transcript can make his/her views known on our WhatsApp platform, for all members to see]
