How SHIF will change access to health care

Health CS Susan Nakhumicha notes that public participation is key in proper implementation of SHIF.

The Government’s actualisation of the new Social Health Insurance Fund (SHIF) is expected to radically change the provision of health care services, making them not only accessible but also affordable to all. SHIF, which is one of the flagship initiatives of President William Ruto’s bottom up economic transformation, is expected to replace the 57-year-old National Health Insurance Fund (NHIF).

Health Cabinet Secretary Susan Nakhumicha notes that the new scheme will ease the financial burden associated with seeking health care services for many families.

“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 What’s App harambees,” said the CS.

SHIF, which will be run by a Social Health Authority, will bank on digital technology to secure patient information and revolutionise the tracking of supply chain processes, therefore, curbing corruption that have plagued its predecessor. “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,” said Nakhumicha. Under SHIF, all salaried workers will contribute 2.75 per cent of their incomes towards the health fund.

Those who earn Sh20,000 will be pay Sh550 while those whose salary is Sh50,000 will contribute Sh1,375. On the other hand, earners of Sh100,000 will be deducted Sh2,750 and those who take home Sh200,000 will pay Sh5,500. Top earners; those who take home Sh500,000 will pay Sh13,750 while those getting Sh1 million and above will pay Sh27,500. “Those who can’t afford the contributions will be covered by the government,” said the CS. This includes those who are categorised as vulnerable by the Ministry of Labour and Social Protection. Unemployed individuals and casual workers who want to self-pay will contribute Sh300.

Every citizen will be expected to contribute making the scheme mandatory for all adults seeking any services form the government. The new health law also makes it compulsory for any foreigner visiting the country for over a year to enlist and contribute to the insurance scheme. Under the new law, the government is required to build at least a health facility for every 5,000 people as part of the attainment of Universal Health Coverage. The good thing with SHIF, according to the CS, is that it covers beyond basic health services, including 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. The transformation of the health sector is backed by three laws, the first which is the Social Health Insurance Act establishes three new funds, that is the Primary Healthcare Fund, the Social Health Insurance Fund (SHIF) and the Emergency, Chronic and Critical Illness Fund.

The regulations introduced will ensure coverage for screenings, transplants, and post-transplant medications

These funds are 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 for services at levels one to three; the Social Health Insurance Fund will cover services at levels four to six, 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,” said the CS.

The second law is the Facility Improvement Financing Act, which will address underfunding in public health facilities, a persistent challenge that has hindered the quality of healthcare services. Through the law, 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.

Lastly is the Digital Health Act, which entrenches into law the use of technology in health care services provision. It aims to establish and maintain a comprehensive integrated health information system for better health services provision. By leveraging on technology, the government seeks to enhance data sharing and resource utilisation, creating a more efficient and responsive healthcare system.

“The digital transformation aligns with global trends seeks to ensure that Kenya’s healthcare infrastructure is not only robust but also capable of adapting to future challenges,” said the CS.

The Ministry of Health is currently undertaking public participation on the Social Health Act, which anchors SHIF into law. “Our projection is that by March 1, we should be able to start registration of everybody into the Social Health Authority,” she said. Dr Ruth Masha, National Syndemic Disease Control Council (NSDCC) chief executive officer, said at a public participation forum that SHIF guarantees Kenyans access to essential medical services. “A major ingredient of the Fund is that it comes with huge financial relief to families. Medical expenses exert substantial financial pressure, tipping many families into poverty. The government seeks to lessen this by scattering the cost of healthcare across the population,” she said.

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