A committee set up by the Ministry of Health to oversee a seamless transition to the new Social Health Insurance Fund (SHIF) has recommended that the planned rollout of the scheme from July 1 be suspended, citing challenges with the digital platform designed to support contributions and registration.
The transition committee on the Social Health Authority (SHA)—the agency created to run the SHIF and replace the National Health Insurance Fund (NHIF) —said in its report that a pilot run on the ICT system showed it wasn’t ready for the shift, with less than a week to go.
The Health Ministry, said the team, should consider carrying on with the NHIF and recalling the already published regulations on the new scheme.
“SHA ICT system was piloted in Marsabit dry run revealed that the new system was not ready and challenges are being addressed and a second repeat dry run that encompasses proxy mean testing may be done thereafter,” the committee said in the report following a meeting last Friday.
“The ICT experts have been requested to report for SHA alternatives on the ICT system especially on the registration and contribution domain. There is a need for an alternative solution even including recalling the SHA regulations and use of NHIF systems and the latter has financial implications. The nature of the contract with the current NHIF system licences and contracts need to be renewed.”
The committee chaired by Dr Jason Kap-Kirwok was inaugurated on January 30, 2024, by Health Cabinet Secretary Susan Nakhumicha.
Ms Nakhumicha in late March published regulations indicating that the SHIF would commence on July 1.
All Kenyans aged above 18 will be required to make mandatory contributions to the SHIF, with billions of shillings marked for financing universal health coverage (UHC).
Under the plan announced by the Health Ministry, Kenyan workers will start paying 2.75 percent of their gross monthly to the SHIF from July 1 —a move that will see contributions for top earners rise by more than eight times in an economy where the take-home of many workers has shrunk due to spiralling inflation.
For example, salaried workers earning up to Sh50,000 a month will face a Sh1,375 deduction under the SHIF, up from Sh1,200 contributed under the NHIF. For a worker earning Sh100,000 a month, the deduction will be Sh2,750, up from Sh1,700 currently paid under the NHIF—representing a 62 percent jump. Those on a Sh500,000 gross pay will see their deductions jump eight times to Sh13,750 unless a cap is introduced.
For lowest income earners, there would, however, be some relief under SHIF. For example, for a worker with a Sh20,000 gross pay, deductions towards SHIF would stand at Sh550 compared to Sh750 under the NHIF.
Kenyans, with no source of income, will also be compelled to pay at least Sh300 every month to the SHIF as the State targets a vast funding pool to finance UHC.
The recommendations by the SHA transition committee, however, put a damper on these plans dealing a blow to the State, especially given the challenges with the NHIF that has even seen some private hospitals cut links with the scheme over unsettled claims.
More than 400 members of the Rural Private Hospitals Association of Kenya (Rupha) in May stopped accepting NHIF cards amid claims that the insurer owed them more than Sh6 billion—a staggering amount that has crippled their operations.
Earlier this year, the Ministry of Health revealed that the ICT system, which would act as a centralised management system for healthcare providers, would cost at least Sh5 billion to set up, an amount that could go down the drain if the proposal to overhaul the NHIF system goes through, leaving Kenyans who are supposed to contribute part of their monthly income to the scheme in a dilemma.
Last month, some Members of Parliament raised concerns about the lack of transparency surrounding the system being used by the SHA to enrol Kenyans into the new health scheme and called on the ministry to suspend the enrolment of Kenyans into the SHIF, which has already begun, until it clarifies how it procured the ICT system being used to enrol members.
The MPs on the Health Committee claimed that the system was procured without due process and put Kenyans’ lives at risk by failing to ensure the security of personal data collected.
“The system being used by the SHA to register Kenyans on the new health scheme is shrouded in ambiguity; we don’t know the name of the IT company being used, the cost involved, or the extent of the data already collected. On the face of it, this appears to be a breeding ground for corruption,” said Anthony Kibagendi, MP for Kitutu Chache South.
Section 47 of the SHIF requires that digitisation and processes be carried out using appropriate, reliable, secure, interoperable, verifiable, and responsive technology through an information system.
The processes and services include registration of members, identification of members, contributions to the fund, empanelment of facilities, execution of contracts, identification of members, notification and pre-authorisation, claims management, and settlement of claims.
It further states that every Kenyan shall be uniquely identified for health service delivery, and the digitisation of processes and services shall comply with the provisions of the Data Protection Act 2019 and all other relevant laws.
The latest development comes at a time when the ministry is yet to commence means testing to identify vulnerable households in need of financial assistance. Under the NHIF, the ceiling is Sh1,700, a figure that will be multiplied for certain cadres of high earners. While the non-salaried used to pay Sh500 per month for NHIF, this will be reduced to Sh300 under the new scheme.
