SHI-SHA-SHIA-SHIFA-SHIF: A New Age of Social Healthcare!

 

 

The pace towards Universal Health coverage is fastening as the current regime is intending to deliver its share of mandate by building from the MTPIII/Big Four Agenda’s healthcare achievements. While KK regime is steadfast in effecting healthcare changes, the government is yet to dissipate the abounding circulating confusions, confusion founded on numerous questions on the ongoing rapid transition of healthcare financing system from the previous National Health Insurance Fund Act, 1998 to the new Social Health Insurance Act, 2023. Questions such as why the impetuous operationalization of the Social Health Authority. In fact, it is hardly comprehensible that the institution has not been fully established to undertake its mandate as per the SHI Act. Concerns such as why can’t the health authorities attain the same outcomes aimed to be achieved by the new frameworks with the National Health Insurance Fund? Questions such as how what exactly does means testing instrument, a mechanism that the authorities intends to employ in determining level of income earned by unsalaried Kenyans especially those who work in the informal sectors? The Boda Boda rider, the mama mboga, Jamaa Wa mkokoteni inter alia. But before I get ahead and by, it is important to understand some context.

Rationale for the new SHIA

Last year, 2023, Kenya marked an outstanding step in its progressive healthcare policy reforms following a successful passage of the Social Health Insurance Act, No. 16 of 2023. This watershed legislation repealed the former National Health Insurance Act of 1998, an Act that had undergone through several reviews before it got repealed by the current SHIA. In the spirit of having effective and efficient healthcare financing system in order to achieve long-term ambition of Universal Health Coverage. Moi’s regime hallmarked healthcare policy legislation by assenting an Act that anchored an array of policy frameworks, notably that established the National Health Insurance Fund in 1988. Although, the Act had undergone through series of reviews, the Fund had been embroiled in myriad of institutional challenges that road blocked its ability to deliver its constitutional mandate of ensuring affordable healthcare financing. It was not immune from endemic corruption, a deep-rooted problems that has affected most government institutions. It is inarguable that beneficiaries of NHIF faced challenges in accessing Fund’s cover in hospitals whenever they feel sick.  In light of aiming to address managerial and institutional shortfalls of this Fund, parliament enacted a new legislation, Social Health Insurance Act which sought to repeal the pre-existing fund and replace it with a new model of public healthcare financing, and introducing other new funds.

Legal frameworks:

In recognition that good health is a fundamental necessity for the country’s economic prosperity, the framers of the constitution of Kenya 2010 through Article 43 mandate the government with a responsibility of ensuring that there is high standard healthcare accessed by the population of Kenya. Further, in the long-term plan of vision 2030, government intends to make highest attainable healthcare into reality by the year 2030. Uhuru’s government and current regime has made remarkable steps in institutional health policy reforms through their political agendas; The Big Four and the Bottom up Economic Transformative Agenda.  Both of them designed to achieve Universal Healthcare coverage. KK regime’s five-pillared economic strategy envisaged Universal Healthcare Coverage as one of its main priorities for the next five years and recent last year’s passage of new social Health Insurance Act has showcased their commitment to continue with previous government efforts to leap up previous regimes’ efforts of improving healthcare financing.

PHF SHIF and ECCIF

In particular, the new Social Health Insurance Act, 2023 establishes three main fund which will managed by Social Health Authority, SHA.

1.   Social Health Insurance Fund {SHIF}, is the successor of NHIF. This fund is primarily aimed at providing health coverage to registered beneficiaries including all Kenyan household and foreigners with long-term residency in the country. The fund will be majorly funded by 2.7% contributions by registered salaried income and annual contribution from unsalaried Kenyan households through a mechanism determined by the accounting officer of ministry of health. The Act mentions the mechanism as a means testing instrument. While the act state that, the cabinet secretary has not provided specificity on the means testing instrument that will be used to determine the annual income of unsalaried households. Other sources of resources include monies appropriated by the National Assembly for indigent and vulnerable person and gifts, grants, innovative financing mechanisms or donations.

2. Primary Health Fund (PHF): This is one is primary designed to purchase primary healthcare services from healthcare facilities. It will derive funding from sources including appropriations from national assembly, grants, donations and fees. This is one is objected towards seamless delivery of critical primary health services to the population. As it stands that government aimed to pump Kenya 50B but national assembly has only appropriated 4B.

3.   Emergency, Chronic, and Critical Illness Fund (ECCIF): If you are a beneficiary of SHIF and your contribution are exhausted, this fund is dedicated to cover costs associated with treating chronic illness and emergency health concerns. Like SHIF and PHC, it is also funded by Nation assembly’s appropriations, grants, and donations.

Kenyans’ take

In defiance of these ambitious institutional reforms, the operationalization of the transitioning Act has sparked mixed reactions and fuelled a raging public discourse about the country’s social health insurance policy. Most Kenyans express their scepticism about the transitioning from National Insurance Health Fund (NHIF) into Social Health Insurance Fund (SHIF), majorly scrutinizing the sense urgency in its implementation. The government has hurriedly migrated Kenyans into SHIF despite serious institutional gaps that have not been established in the general regulations, 2024. The quick moves have left Kenyans questioning the genuineness of this transition and whether these changes will effectively and efficiently improve healthcare security in this country.

As many Kenyans grapple with unanswered questions regarding justification and rationale for  these changes, the government persuades that establishment of primary health fund, social health insurance fund and emergency chronic and critical illness fund are dedicated to improving healthcare  towards achieving  ultimate ambition of Universal Health Coverage  envisaged in  government long-term plan, constitution of Kenya, Medium plan Four, sector master plans, sustainable development goals and other regional development plans relevant to country’s healthcare priorities.

As the country is sailing through this transformative metamorphic phase in its healthcare outlook, it is important for Kenyans to keep themselves informed and understand implication of this new act. It is fundamentally important to engage in discourses with the aim of challenging policy makers by providing feedbacks and participating in processes that ensure that your healthcare plans are safe and secure.