Kenya’s Race Against Time to Transition to a Social Health Insurance Fund (SHIF)
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Kenya’s Race Against Time to Transition to a Social Health Insurance Fund (SHIF)

Kenya’s Race Against Time to Transition to a Social Health Insurance Fund (SHIF)

Kenya was expected to introduce a new healthcare financing model, the Social Health Insurance Fund (SHIF), on July 1, 2024. The imminent transition from the National Health Insurance Fund (NHIF) to the Social Health Insurance Fund (SHIF) promises to revolutionize healthcare to realize the dream of Universal Health Coverage (UHC), a key pillar of the country’s development agenda and an integral part of the Kenya Kwanza government’s Bottom-Up Economic Transformation Agenda (BETA).

However, a cloud of uncertainty hung over the implementation of the new health plan, with citizens indicating that July 1 was too early and that they were not ready to transition to SHIF.

Promise

SHIF marks a shift from voluntary to mandatory health insurance, in line with Article 43 of the Kenyan Constitution, which guarantees every citizen the right to the highest attainable standard of health care. It was designed to overcome the challenges that have plagued NHIF since its inception in 1966, such as limited coverage, inefficiencies in claims processing and allegations of corruption. These long-standing problems have significantly hampered Kenya’s progress towards UHC, leaving a significant portion of the population vulnerable to catastrophic health care expenditures.

SHIF aims to change this by transforming Kenya’s healthcare system and drastically expanding coverage, particularly for informal sector workers and economically vulnerable groups. Say goodbye to the old NHIF and hello to the new SHIF. But what does SHIF bring to the table?

  • Mandatory universal insurance for all Kenyans
  • Improving the efficiency and quality of health services
  • Reduced citizens’ own expenses
  • Equal access, with particular attention to groups at risk of exclusion
  • Extended scope of protection for informal sector workers
  • Access to a wider range of healthcare services
  • Increased funding for the entire healthcare system
  • Emphasis on preventive care and better treatment of chronic diseases

However, as with any major systemic change, SHIF’s success will depend on effective implementation and the ability to overcome challenges that have hindered previous healthcare reform efforts. While on paper it seems like a progressive move, its true impact remains to be seen.

Reality Check: Lessons from “Transition to SHIF”

As the time approaches for the implementation of this major healthcare reform, the recent Sauti za Wananchi report, ‘Transitioning to SHIF: Time for Health Check-up’ published by Twaweza East Africa, sheds light on key aspects of this transformation, revealing the stark contrast between promises and reality.

The report’s findings paint a dire picture of the current state of health insurance in Kenya. Only half of Kenyans (53%) currently have some form of health insurance, a statistic that underscores the scale of the challenge in achieving universal coverage. It raises critical questions about the feasibility of mandatory insurance for all Kenyans, especially given the country’s large informal sector.

While NHIF members appreciate the quality and affordability of the services provided (71% of members), significant challenges remain. Almost half (49%) of NHIF members complain that it does not cover all ailments, and more than a third (36%) are frustrated that they can only use services from specific hospitals.

The report also highlights persistent problems in the current healthcare system that SHIF needs to address. Citizens overwhelmingly point to two major challenges: the lack of availability of medicines in healthcare facilities (mentioned by 46% of respondents) and the high cost of healthcare (mentioned by 23% of respondents). These are not new problems, but they are issues that SHIF must address if it is to succeed where NHIF has struggled. The transition to SHIF presents an opportunity to address these long-standing issues and truly transform access to healthcare for all Kenyans.

Information gap

One of the most glaring issues highlighted during the launch is the significant information gap surrounding SHIF. Despite its imminent implementation, many Kenyans remain in the dark about what SHIF covers, how it will affect them and what they need to do to comply. This lack of awareness is in stark contrast to Article 35 of our Constitution, which guarantees citizens the right to access information held by the state.

Despite attracting health stakeholders, many have expressed an urgent need to learn more about SHIF. This information gap is not just a public relations issue; it poses a serious threat to the success of SHIF launch and subsequent implementation. Without proper public understanding and acceptance, the transformation is vulnerable to resistance, lack of compliance, and ultimately failure to achieve goals.

Technical readiness

In addition to concerns about public awareness, there are serious questions about the technical readiness of the SHIF implementation. Less than a week before the July 1 launch date, serious concerns have been raised about the readiness of the digital infrastructure necessary to support SHIF. The SHIF Transition Committee stated in its report that the pilot launch of the ICT system showed that it was not ready less than a week before the planned switchover. The panel suggested that the Ministry of Health consider continuing the NHIF and withdrawing the regulations already issued for the new system. The SHIF Transition Committee report highlights concerns about the integration of digital health systems and the security of medical records.

In an era where data breaches are becoming more common and privacy concerns are paramount, these issues cannot be ignored. The success of SHIF will depend largely on a solid, secure and efficient digital infrastructure. Any shortcomings in this area could undermine public trust and the overall effectiveness of the new system.

The Financing Puzzle

Perhaps one of the most contentious issues surrounding the implementation of SHIF is the issue of funding. Dr Brian Lishenga, chairman of the Rural and Urban Private Hospitals Association of Kenya, expressed serious concerns about the underfunding of the public health system. He highlighted the significant shortfall in the National Health Insurance Fund (NHIF) and criticised the proposed budget for primary health care as being significantly lower than other health facilities covered by level 4 and 5 hospitals.

This funding gap is particularly worrying given the ambitious scope of SHIF. The new system promises comprehensive coverage, covering everything from outpatient services to treatment abroad. But without adequate funding, these promises risk remaining just promises. There are legitimate concerns that underfunding could lead to a decline in the quality of care, particularly in lower-tier facilities that serve the majority of Kenyans.

Have we learned any lessons from the past?

The push to quickly implement SHIF has an uncomfortably reminiscent feel to the rushed rollout of the Competency-Based Curriculum (CBC) in 2017. In both cases, political considerations seem to be driving the timeline more than practical readiness. The question is: Are we witnessing history repeating itself, with political expediency taking precedence over careful planning and integration?

The potential consequences of rushed implementation cannot be overstated. A poorly executed implementation could undermine public trust, strain an already strained health system, and ultimately reverse Kenya’s progress towards UHC.

A call to pause and reflect

Given these many challenges, it is clear that the July 1 implementation date was too ambitious. What Kenya needs now is not a rushed implementation but a thoughtful, inclusive approach to healthcare reform. Here is what we should consider:

  1. Delay implementation: Allow for proper system testing, stakeholder engagement, and public education. A few months of delay can mean the difference between success and failure.
  2. Comprehensive public education campaign: Leverage media houses, community health workers, and digital platforms to launch a broad-based information campaign. Twaweza’s report found that nearly 70% of respondents were aware of the role of community health workers, indicating that targeted information campaigns can be effective.
  3. Real public participation: Engage in meaningful public participation, as mandated by our constitution. The Twaweza report highlights the importance of including citizens’ perspectives in policy discussions. It is not just about compliance; it is about creating a system that truly meets the needs of Kenyans.
  4. Review and revise the benefit package: Ensure that the SHIF benefit package truly serves all Kenyans by addressing concerns about potential negative impacts on lower-tier hospitals. This may require a phased approach to implementation, starting with basic services and gradually expanding coverage.
  5. Invest in capacity building: Health workers, especially at the community level, will be critical to the success of SHIF. Significant investment in training and support for these frontline workers is essential.
  6. Address Primary Healthcare Financing: As Dr. Lishenga emphasized, underfunding of primary health care is a critical issue. A successful SHIF must have a solid foundation in primary health care, which requires adequate financing and support.
  7. Strengthen digital infrastructure: Invest in robust, secure digital systems to support SHIF. This includes not only systems for registration and claims processing, but also measures to protect patient data and ensure seamless integration across care levels.
  8. Develop clear accountability measures: Establish clear oversight and accountability mechanisms. This includes regular reporting of key performance indicators, independent audits, and clear channels for public feedback and complaints.

The way forward

Health is not just a constitutional right; it is the cornerstone of a healthy future for our nation. As we embrace this significant change, let’s make sure we get it right. SHIF has the potential to transform healthcare in Kenya, but only if implemented with thoughtfulness, transparency and genuine public engagement. The days ahead will be crucial. Will our leaders heed the calls for a more balanced approach, or will political considerations push us into uncharted waters? As citizens, we need to stay informed, ask questions and demand a healthcare system that truly works for all Kenyans.

We must also recognize that moving to SHIF is not just a matter of changing systems; it is a fundamental shift in how we approach health care financing as a nation. It requires a mindset shift, from viewing health insurance as an option to viewing it as a civic duty and a fundamental right.

Moreover, the success of SHIF will depend not only on government action but on the active participation of all stakeholders. Healthcare providers must be willing to adapt and build capacity for new systems and processes. And individual citizens must be prepared to engage with the system, understanding both their rights and responsibilities.

We must also focus on the ultimate goal: improving the health and well-being of all Kenyans. SHIF is not an end in itself, but a means to achieve better health outcomes, reduce financial hardship caused by healthcare costs and ultimately contribute to the socio-economic development of our nation. Time is running out.

July 1 may be too soon to implement SHIF, but with the right approach, we can ensure that when it does happen, it will be a system we can all believe in and benefit from. Let’s learn from the past, address the concerns raised in the Shifting to SHIF report, and work together towards a healthier future for all Kenyans.

The health of our nation depends on getting this right. Let us rise to the occasion and create a health system that truly serves all Kenyans, now and for generations.

Written by Filbert Mbugua – Youth Studies Consultant at Twaweza East Africa and may be contacted by [email protected]

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