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Mr Elijah Wachira's Biography in Summary

The National Health Insurance Fund (NHIF) exists to provide medical insurance coverage to Kenyans, but it has struggled to protect itself from employee-driven fraud.

The game of musical chairs has continued at the NHIF, as have accusations and counter-accusations of fraud, even as many members struggle to get value for the monthly premiums they pay for health insurance.

This is the environment into which Elijah Wachira, the newly appointed NHIF managing director, will step as he takes on the mantle at a time when the government is also looking to increase the delivery of affordable healthcare for all.

Mr Wachira, a seasoned insurer, has previously worked for private insurers such as CIC General Insurance, where he served as managing director from 2015 to 2019, leading the company's annual premium growth from Sh7.9 billion to Sh12 billion.

He also spent three years as general manager at AAR Health Services before joining Madison Insurance in November 2010 in a similar role. He then joined Gateway Insurance.

Mr Wachira, who previously worked as a business development and insurance consultant, now hopes to use his experience to help the NHIF get its house in order and succeed in an area where others have struggled.

The NHIF has faced allegations of staff-driven fraud, with many insured patients complaining of delays in the approval of medical bills.

There have also been complaints about lower approvals forcing insured people to pay for hospital bills and prescription drugs.


Mr Wachira will be at the center of NHIF's transition to the new fund, which will phase out the State corporation established in 1966.


At the same time, he must ensure that the millions of Kenyans who rely on the fund receive adequate value for their premiums.

He will lead six key functions, including beneficiary and provider management, internal audit, and technology.

Mr Wachira must strike a delicate balance between disbanding the NHIF and establishing three new funds while maintaining health-care delivery.

The Social Health Insurance Bill 2023 seeks to disband the NHIF and establish a Social Health Authority in charge of three funds: primary healthcare, healthcare, and emergency, chronic, and critical illness funds.

Mr. Wachira has an MBA in Strategy and Marketing from the University of Nairobi and a Bachelor of Arts from Egerton University.

He is a member of the Chartered Insurance Institute (CII) in London and the Marketing Society of Kenya (MSK).

Mr Wachira has extensive experience in the general insurance business in both Kenya and the East African region. He specializes in strategy formulation and implementation.


 

He discovers a staff of over 1,800 people who have been thrown into panic mode by the transitional clause in the Social Health Insurance Bill, which requires current NHIF employees to apply for jobs again and only be hired on merit when the NHIF is disbanded to make way for the three funds.

Many NHIF employees have expressed concern about the proposal.

More Kenyans have signed up for national coverage as a result of a sustained government campaign, with the total reaching 15.4 million by the end of June last year.

Health Cabinet Secretary Susan Nakhumicha announced in mid-June that the state would conduct a lifestyle audit on all NHIF employees as part of a crackdown on staff-aided fraud.


Her comments followed the suspension of eight NHIF branch managers over allegations of using traditional tactics to exploit the insured and the Fund.

"We are going to start an elaborate lifestyle audit on all NHIF employees. This is to ensure that each employee can explain how their wealth portfolio differs from their earnings," Ms Nakhumicha stated at the time.

This audit, combined with the government's desire for a fresh start in social insurance, means that Mr Wachira will play an important role in calming the staff and gaining full commitment to their work in the run-up to the transition to the three proposed funds.


The NHIF has struggled to maintain stability, despite the fact that millions of Kenyans continue to rely on it to pay their medical bills.

Wachira succeeded Peter Kamunyo, a medical doctor who worked to address the numerous governance issues that have become synonymous with the State Corporation.

Following Dr. Kamunyo's departure at the end of his term, the board appointed Samson Kuhura to serve on an interim basis.



The medic had taken over the NHIF from Nicodemus Odongo, who had served in an acting capacity after Geoffrey Mwangi was ousted for alleged corruption.

Mr Mwangi's charges for abuse of office were dropped earlier this year. His predecessor, Simeon ole Kirgotty, who had completed his three-year term, was caught up in a corruption investigation and charged after leaving.