- The Ministry of Health to constitute a committee to assess the effectiveness of SHA to help make informed recommendations.
- Exceeding specified limits may require the beneficiary to co-pay as part of a shared responsibility.
- Households are given allowable limits of 180 days per year.
Reports of the Social Health Authority (SHA) being mulfunctional and failing to serve the interests of Kenyans have flared, creating nervousness and doubt about the effectiveness of the long-overhyped health insurance system.
The Ministry of Health, in response to the grievances raised by a couple of Kenyans, has decided to constitute a committee charged with reporting on the shambols and effectiveness of SHA for short- and long-term intervention to ensure that the needs of every Kenyan are met.
“As such, the Ministry is in the process of constituting a committee pursuant to Regulation 41 of the Social Health Insurance Regulation to review tarrifs and benefits.
“Based on feedback from stakeholders gathered over time, the committee will be expected to review and provide practical solutions and make informed recommendations. The Committee report will address both short- and long-term interventions to ensure SHA sustainability and responsiveness to the needs of Kenyans,” Harry Kimtai, Principal Secretary, Medical Services, said.
The government has stayed firm that SHA is proactively addressing challenges about its implementation plaguing Kenyans since it’s launch two months ago by enabling access to health services like cancer management.
“SHA is proactively addressing emerging challenges to ensure seamless access to all services like cancer management, renal care, maternity, and outpatient care. We are committed to removing any barriers that may hinder access, ensuring beneficiaries face no hurdles in obtaining the care they need.”
SHA was rolled out on October 1st, 2024, replacing the NHIF Act of 1998 to enable seamless healthcare accessibility from healthcare providers through the established funds: the Socail Health Insurance Fund (SHIF), now Taifa Care, the Primary Healthcare Fund (PHCF), and the Emergency, Chronic, and Critical Illness Fund (ECCIF), the ministry clarified.
The ministry of health was responding to a circular concern surfacing on social media platforms, where Kenyans seeking healthcare from various facilities were forced to bill themselves out by paying more than 90% of the total accumulated cost.
According to the ministry, SHA’s coverage is based on tariffs to the benefits, available on the platform’s website, which elaborates on a shared responsibility for sustainable healthcare coverage. The ministry has also said that beneficiaries may be required to co-pay in cases where hospital charges exceed the specified limits.
“In cases where the hospital charges exceed specified limits, beneficiaries may be required to make co-payments.”
The ministry has also clarified that admissions to the critical care units and high dependency units (ICU & HDU), which SHA provides, shall be on a per diem basis depending on the level of the facility a beneficiary chooses to visit.
Those admitted in Level 4 healthcare facilities will incur Ksh. 3,360 per day, Ksh. 3,920, and Ksh. 4,480 per day for both Level 5 and Level 6 hospitals, respectively. For any amount exceeding the mentioned cover limits, members will have to top up, with each household having an allowable limit of 180 days per year. The rates are the same across public, faith-based, and private hospitals, the ministry said.
“Each household has a limit of 180 days per year for access rules. Members can access service from empaneled and contracted Level 4-6 facilities. The members will top up any amount that exceeds the above cove limit (Co-pay). The cover limit is the same for Public, Faith-based, and Private facilities.”
The implementation of SHA has been massively criticised by many Kenyans and a section of healthcare providers, as many have been forced to dive deeper into their pockets to supplement the paltry coverage by the SHA. Many Kenyans who don’t have the money to facilitate their needs are forced to go back home, according to what NHIF offered.
