No more Linda Mama? What you need to know about SHIF
Mother with sick child. The new UHC laws have not explicitly indicated the fate of Linda Mama scheme, a question troubling reproductive health campaigners.
What you need to know:
- Under UHC, all Kenyans and non-Kenyans including new-borns will have access to a “full range of quality health services they need".
- Every Kenyan and non-Kenyan, are to be registered to the Social Health Insurance Fund.
The new UHC laws have not explicitly indicated the fate of the Linda Mama scheme, a question troubling reproductive health campaigners.
Transition to the era of universal health coverage (UHC) is taking shape with the unveiling of the board of Social Health Authority chaired by Dr Timothy Olweny.
A new institution born out of the Social Health Insurance Act (SHIA) which came to be last year alongside three other sister laws namely Primary Health Care Act, Facilities Improvement Financing Act and Digital Health Act, anchored as the pillars of the UHC.
Under UHC, all Kenyans and non-Kenyans including new-borns will have access to a “full range of quality health services they need, when and where they need them, without financial hardship,” as defined by the World Health Organisation.
While the SHIA offers that, UHC would ensure “individuals and communities receive the health they need including the full spectrum of essential, quality health services from health promotion to prevention, treatment, rehabilitation, and palliative care without suffering financial hardship.”
And every Kenyan and non-Kenyan, are to be registered to the Social Health Insurance Fund (SHIF).
The law says every registered beneficiary is entitled to an essential healthcare benefits package prescribed by the Cabinet Secretary in consultation with the board.
Needy persons
The Cabinet Secretary for Health Susan Nakhumicha, has consistently told the public the government will cover the social health premium for the indigents described in the SHIA as poor and needy persons who cannot meet their basic needs in life.
To determine the indigents, a Social Health Authority mandated with registering the beneficiaries, would subject the targeted individuals to means testing. The testing would establish whether an individual or a household has the ability to pay for their social health insurance premium.
The SHIA considers a household as a social unit comprising an eligible contributor, whether contributing by self or paid for, and their beneficiaries, or who share the same social economic needs associated with consumption and production.
Non-salaried
SHIA regulations require salaried households to contribute 2.75 per cent of their gross salary or wage to the fund.
The non-salaried will also contribute the 2.75 per cent of the proportion of its household income as determined by the means testing instrument.
The instrument is a set of indicators that capture various socio-economic aspects of an individual or a household for purposes of conducting means testing.
Where does this leave the Linda Mama scheme?
In June 2013, then President Uhuru Kenyatta launched the provision of free maternity services in public health facilities as a way of eliminating financial barriers in accessing maternal healthcare by mothers seeking maternity services in public health hospitals.
In 2016, the Ministry of Health transitioned the provision of the services to the now repealed National Health Insurance Fund (NHIF) and rebranded it Linda Mama programme.
Linda Mama came with an expanded package providing a 12-month coverage-for nine months during the pregnancy and three, post-delivery. It covered ante-natal clinic visits, deliveries including its related complications, post-natal clinics and care for the new-borns.
The new UHC laws have not explicitly indicated the fate of the scheme, a question troubling reproductive health campaigners.
During a Monday Report show at Citizen TV on February 5, 2024, Centre for Reproductive Rights, legal strategies for Africa, associate director, Martin Onyango sought answers from Dr Olweny.
NHIF architecture
He asked: “In the current set up, the few questions we would want to ask are; where is the provision for maternity healthcare, in particular complications during childbirth? Pregnancy complications like ectopic pregnancy, safe abortion services, contraceptives? Where is that provided in the regulations (Social Health Insurance (General) Regulations, 2023).”
Dr Olweny responded: “Linda Mama was just one of the programmes we had within the NHIF architecture. The new thinking was if our approach is to go universal and now we are covering people based on households, those mamas come from particular households. So, if our objective is to cover all households, then mamas will also be covered. So, there is no need to provide for them separately.”
He continued: “There will be one standard package for everybody. It is comprehensive because it covers delivery services and other reproductive services, which you are talking about. Complications are covered if you look at the benefits which we are going to look at in terms of public participation.”
