The long-awaited shift from the National Hospital Insurance Fund (NHIF) to the Social Health Insurance Fund (SHIF) is not just approaching—it is here. However, the Kenya Union of Clinical Officers is expressing concerns about the readiness of Kenyans for this transition.
George Gibore, the Union’s Secretary General, stated, “The government should have taken more time to consider the transitioning process, especially given the financial constraints and the infrastructure challenges facing most level 2, 3, and 4 hospitals. Some of us expected this change for some time, but it was never implemented because we were never prepared for it, and my feeling is that we are still not prepared.”
He emphasized that both medical practitioners and the public are not adequately ready for the shift, pointing out that the SHA act requires individuals to pay more. “It is the government’s responsibility to identify those who are supposed to benefit from the programme so that people can trust the process,” he added.
Gibore also highlighted issues with the funding under SHA, noting, “We have three funds: the Primary Care Health Fund, which is a government fund projected at a budget of Kshs 50 billion. Unfortunately, they are only providing Kshs 4.1 billion, which is just a drop in the ocean without proper studies to support this budget.”
He further mentioned that the government was expected to allocate another Sh 100 billion for the Emergency and Critical Care Fund, but those funds have now been redirected to address chronic illnesses, cancer issues, and other emergencies that may arise.
“For this year, they project that their budget would be Kshs 70 million, but what did we get? Only Kshs 2.9 million, so if this is the money we received, look at the percentage that will be able to offer the services required,” he added.
The emergency and critical care for the primary health care fund, he said, is expected to provide for level 2, 3, and 4 hospitals.
“You see, the money we will be depending on is the one that we are waiting for people to contribute. What about the 1.8 million people who have already paid for SHA? How are they transitioning those who had paid for the NHIF? This is a very big problem,” he said.
He noted that there is a need for a clear structure for the transition.
“My sentiments are that the government is not prepared to transition to the SHA programme, financially, and the infrastructure is not well put,” he added.
Earlier, Medical Services Health Principal Secretary Harry Kimtai stated that registration for the new scheme is a must for all Kenyans. Kimtai insisted that SHA will serve all Kenyans, unlike NHIF, which he said was discriminatory and mostly favored the employed. Presidential advisor on health and health economist Daniel Mwai added that healthcare financing has been a major challenge in the country, an area that has been corrected under SHA.
Dr. Mwai stated that the system is a creation and improvement informed by past systemic failures. The new scheme entails pooling risks and establishing a premium. According to Mwai, NHIF heavily targeted 20 percent of Kenyans in formal employment, leaving out 80 percent in the informal sector, all of whom are included in the new scheme.
In the new scheme, deductions have been capped at 2.75 percent, with low-income earners paying less compared to NHIF. For instance, a person earning Kshs 3,000 will pay Kshs 82.50, compared to the current monthly deductions of Kshs 150 to NHIF.
Mwai emphasized that NHIF also did not provide adequate insurance for patients with chronic diseases who need services like chemotherapy and dialysis. Under SHA, the exchequer will cater to the Primary Healthcare Fund and Emergency and Critical Care Insurance Fund (ECCIF), while contributions will be made to the Social Health Insurance Fund (SHIF). Patients who deplete their SHIF will still have access to care through ECCIF. The new scheme also eliminates premiums, providing standardized services regardless of the amount contributed.
