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Sustainable contributions pool solution to SHA woes

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By  Editorial

The Social Health Authority (SHA) is proving to be a bridge too far in healthcare provision. The expectations from the rollout of its Social Health Insurance Fund (SHIF) are yet to be met despite the government’s constant reassurances.

From recent reports presented to MPs, SHA, it seems, is in intensive care. Although 29 million people are registered, only five million pay their monthly premiums. It sometimes covers less than 15 per cent of treatment costs, shifting a higher financial burden to patients.

According to available statistics, more than 80 per cent of the country’s 19.9 million workers are in the informal sector, where earnings are unpredictable. There are just 3.1 million salaried employees. However, many in the informal sector join the fund when sick and disappear after enjoying the full benefits. But for every shilling an informal sector worker contributes to the SHA, it pays out over Sh26 in claims, and the ratio is increasing. This is unsustainable.

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The universal health coverage (UHC) dream is threatened as the new system reels under pressure from debts to hospitals. When it was launched in October 2024, replacing the National Health Insurance Fund (NHIF), it was touted as a medical scheme for everyone. The authority targets 85 per cent population coverage, of 43 million Kenyans, with an average premium of Sh14,090 per household needed to sustain the fund.

CEO Mercy Mwangangi says the agency does not have enough funds to settle medical bills. It has collected Sh159.34 billion since inception and disbursed Sh122.34 billion to healthcare providers, generating a net operating surplus of Sh36.99 billion. The NHIF had a net deficit of Sh2.26 billion in its final year.

The SHA was built on the principle that if everyone contributes, the healthy subsidise the ill, the young cater for the old, and the system sustains itself over time. That model failed under the NHIF due to mismanagement and fraud.

The culture of paying in advance to create a sustainable pool is the long-term solution. It requires building trust in the system, simplifying processes, and enhancing enforcement mechanisms.

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