The Emergency, Chronic, and Critical Illness Fund (ECCIF) plays a critical role in Kenya’s healthcare system. It is designed to provide financial assistance to Kenyan residents during health crises and to ensure that no individual is denied necessary medical treatment due to financial constraints. As a government-funded initiative, ECCIF offers universal access to emergency medical services and comprehensive coverage for chronic and life-threatening conditions.
READ ALSO: Benefits Financed by the Social Health Insurance Fund (SHIF)
This fund acts as a safety net for all Kenyans, bridging the gap between the Primary Healthcare Fund (PHF) and the Social Health Insurance Fund (SHIF), offering support for emergency services, critical illnesses, and chronic diseases. It provides vital services, including ambulance evacuation, accident and emergency treatment, critical illness care, palliative care, and assistive devices.
Key Features of the Emergency, Chronic and Critical Illness Fund (ECCIF)
- Government-Funded: Like the PHF, the ECCIF is entirely financed by the Kenyan government. This makes it accessible to all Kenyan residents, ensuring universal healthcare coverage for emergencies and critical illnesses.
- Universal Access to Emergencies: One of the key features of the ECCIF is its universal access. All residents of Kenya, whether they are registered under the Social Health Authority (SHA) or contribute to the SHIF, can access emergency services. This includes a wide range of emergency health situations, such as road accidents, heart attacks, strokes, and other life-threatening conditions.
- Chronic and Critical Illness Coverage: The ECCIF extends its financial aid to individuals suffering from long-term and life-threatening illnesses. This includes treatments for diseases such as cancer, kidney failure, and heart disease. Through this coverage, the ECCIF helps reduce the financial burden on patients and their families while improving access to essential healthcare services.
- No Upfront Payments: In emergency situations, Kenyan residents are not required to make any upfront payments to receive healthcare services covered under the ECCIF. This ensures that individuals facing sudden health crises can receive life-saving treatment without the worry of immediate financial strain.
Who Benefits from the Emergency, Chronic and Critical Illnesses Fund (ECCIF)?
Every Kenyan resident, regardless of whether they are registered under the SHA or contribute to SHIF, can benefit from the ECCIF. The fund provides financial coverage for emergencies, chronic diseases, and critical illnesses.
Even those not enrolled in the SHIF can access emergency services, making this fund a critical aspect of Kenya’s healthcare safety net.
Benefits Financed by the Emergency, Chronic and Critical Illnesses Fund (ECCIF)
1. Ambulance Evacuation Services
The ECCIF provides ambulance services for the evacuation of patients from the point of an emergency incident to the nearest healthcare facility equipped with an Accident & Emergency (A&E) center. This service ensures that patients receive prompt and timely medical attention, which can be crucial in life-threatening situations.
Scope of Cover: Evacuation from the site of the incident to the nearest facility with A&E services and transfer of patients needing further clinical care.
Access Point for Services: All transfers and evacuations are managed through a National Ambulance Call Centre.
Tariff:
- 25 km radius (Intra metro) – KES 4,500
- > 25 km (Extra metro) – KES 75 per km
Access Rules: All Kenyans can access this service, irrespective of their registration or premium payment status.
2. Accident and Emergency Services
The ECCIF covers a wide range of accident and emergency services to ensure that all Kenyans can receive immediate treatment for life-threatening conditions, such as cardiac arrest, major trauma, seizures, and more.
Scope of Cover: Includes treatment for cardiac and pulmonary arrest, major trauma, shock, altered levels of consciousness, chest pain (indicative of stroke), anti-snake venom, and anti-rabies treatment.
Access Point for Services: Available at Level 2 to 6 healthcare facilities.
Tariff: Fee-for-service basis.
Access Rules: Available to all Kenyans. Care is covered for a maximum of 24 hours, after which SHIF benefits are activated for paid-up members.
3. Critical Illness Services
This benefit provides coverage for individuals suffering from critical illnesses, allowing them to receive essential treatment in critical care units.
Scope of Cover: Includes care for critical illness admissions in critical care units.
Access Point for Services: Available at Level 4 to 6 facilities.
Tariff: Per diem rate, similar to the inpatient benefit package where members will top up amounts exceeding the cover limit.
Access Rules: Limited to inpatient bed days (180 days per household).
4. Palliative Care Services
Palliative care services focus on improving the quality of life for patients with chronic or life-threatening illnesses. This care includes symptom management, psychosocial support, caregiver support, and end-of-life care.
Scope of Cover: Palliative care services to enhance quality of life for patients with serious chronic or life-threatening illnesses.
Access Point for Services: Available at Level 3 to 6 healthcare facilities.
Tariff: Per diem rate, similar to the inpatient benefit package.
Access Rules: Limited to inpatient bed days (180 days per household).
5. Assistive Devices
The ECCIF provides assistive devices to individuals with permanent physical and sensory disabilities and progressive chronic conditions such as Parkinson’s disease and multiple sclerosis. These devices support individuals in their daily activities and improve their quality of life.
Scope of Services: Provision of assistive devices like hearing aids, walking frames, wheelchairs, clubfoot braces, and therapeutic footwear.
Access Point for Services: Available at Level 4 to 6 healthcare facilities.
Tariff:
- Hearing aids – KES 55,000
- Walking frames – KES 500
- Wheelchair – KES 15,000
- Clubfoot brace – KES 1,000
- Therapeutic footwear – KES 1,000
- Crutches – KES 900
Access Rules: Hearing aids are limited to individuals aged 18 and below and are issued once per lifetime. This package will be rolled out in Year 2 based on the maturity of the fund.
Exclusions from the Emergency, Chronic and Critical Illnesses Fund (ECCIF)
- While the ECCIF covers a wide range of emergency, chronic, and critical illness services, there are certain exclusions, including:
- Cosmetic procedures not specified in the surgical listing.
- Treatment by chiropractors, acupuncturists, and herbalists.
- Assisted fertility treatments such as IVF.
- Vaccines outside the Kenya Expanded Program on Immunization (KEPI).
- Products not included in the Kenya Essential Medicine List (EML) or the Kenya Essential Diagnostics List (EDL).
- Medical costs incurred in research environments or clinical trials.
- Epidemics, pandemics, and weight management drugs.
- Expenses related to diagnostic equipment such as glucometers.
- Professional fees for medical personnel beyond prescribed rates.
NOTE: Vertically Financed Programs
Programs like ARVs, antimalarials, anti-TB treatments, and family planning commodities will continue to be provided through public, faith-based, and private facilities reporting to the national health information system.
Conclusion
The Emergency, Chronic, and Critical Illness Fund (ECCIF) is a vital component of Kenya’s healthcare system. It offers universal access to emergency services and financial coverage for chronic and critical illnesses, ensuring that no Kenyan is left behind in times of medical need.
READ ALSO: Benefits Financed by the Primary Healthcare Fund (PHF)
This government-funded initiative supports individuals during medical emergencies and long-term health challenges, making healthcare more accessible to everyone in the country. The ECCIF not only enhances the quality of healthcare but also provides peace of mind for Kenyans facing unexpected medical challenges.
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