Social Health Insurance Fund will change healthcare in Kenya

Dr Timothy Olweny

Social Health Authority Chairman Dr Timothy Olweny.

Photo credit: Nation Media Group

Kenya is on the cusp of a transformative era in healthcare with the ongoing implementation of the Social Health Insurance Fund (SHIF).

The Social Health Authority (SHA) is poised to replace the decades-old National Health Insurance Fund (NHIF), which has been marred by corruption scandals leading to the loss of billions in taxpayer-contributed funds.

One pivotal aspect of the SHA is its commitment to a secure digital information system. This system promises to revolutionise the tracking of supply chain processes, putting an end to the scandals that have plagued health commodities and procurement in the past.

The transparency afforded by this digital system will ensure that resources are allocated efficiently, instilling public trust in the healthcare procurement process.

The new system is a response to the urgent need for accountability, prudent spending and prevention of pilferages.

While critics argue that SHIF will exacerbate the cost of living crisis, as Health Cabinet Secretary, I know that there is no higher cost for a nation than allowing people to die from treatable and preventable diseases.

The government recognises the hardship faced by families who lose their only properties and savings to a single case of illness in the family. SHIF is a comprehensive approach that legally marshals the entire country to share the healthcare burden — a departure from traditional and WhatsApp harambees.

Under the new system, all citizens are expected to contribute 2.75 percent of their income towards the health fund. Those unable to afford contributions will be covered by the government. Unemployed Kenyans, who were previously paying Sh500 per month to the NHIF, will now pay Sh300 in a graduated arrangement based on their ability to contribute. This progressive approach aims to bring equality and equity into healthcare provision in Kenya.

SHIF does not merely address basic health services; it encompasses a wide range of healthcare services, ensuring that Kenyans have access to quality healthcare across various medical needs.

The inclusion of services such as screening, drug rehabilitation, mental health support, physiotherapy, CT scans, MRI, PET scans, X-rays, brachytherapy, outpatient and inpatient services, HIV testing, cancer screening, family planning, maternal and child clinics, surgeries, emergencies, including ambulance services, cardiac arrest, accidents, and even transplant procedures demonstrates the government's commitment to providing holistic healthcare coverage.

The foundation of this healthcare revolution lies in four pivotal laws geared towards Universal Health Coverage: the Primary Health Care Act, 2023; the Digital Health Act, 2023; the Facility Improvement Financing Act, 2023; and the Social Health Insurance Act, 2023.

These laws collectively provide a legal and institutional framework for the successful rollout of Universal Health Coverage, promising to transform healthcare in Kenya fundamentally.

The Social Health Insurance Act, in particular, represents a paradigm shift. It has repealed the problematic NHIF and established three new funds: the Primary Healthcare Fund, the Social Health Insurance Fund and the Emergency, Chronic and Critical Illness Fund.

These funds are strategically designed to cover various levels of healthcare services, from primary to emergency and chronic care, ensuring that no Kenyan is denied emergency medical treatment, as enshrined in Article 43(2) of the Constitution.

The Primary Healthcare Fund will cater to services at levels 1 to 3, the Social Health Insurance Fund will cover services at levels 4 to 6, and the Emergency, Chronic and Critical Illness Fund will handle costs once social health insurance is depleted. This tripartite structure not only fulfills constitutional mandates but also addresses the practical aspects of healthcare delivery, ensuring a seamless and comprehensive coverage system.

In addition to the SHI Act, two other laws play crucial roles in fortifying Kenya's healthcare infrastructure: The Facility Improvement Financing Act and the Digital Health Act. The Facility Improvement Financing Act directly tackles underfunding in public health facilities, a persistent challenge that has hindered the quality of healthcare services.

By addressing this issue head-on, the government aims to enhance the capacity and capabilities of public health facilities, providing better services to all citizens by collecting, retaining, and planning for use of revenues generated from facilities.

The Digital Health Act, on the other hand, signals a leap forward in technology adoption for healthcare in Kenya. It aims to establish and maintain a comprehensive integrated health information system that links all the major pillars of UHC, i.e. Health Commodity, Health Financing and Human Resources for Health.

By leveraging on technology, the government aims to enhance data sharing and resource utilization, creating a more efficient and responsive healthcare system. This digital transformation aligns with global trends and ensures that Kenya's healthcare infrastructure is not only robust but also capable of adapting to future challenges.

The writer is the Cabinet Secretary for Health.

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