The Social Health Authority (SHA) may not be sustainable and cannot meet its obligations, the National Assembly departmental committee on health has revealed.
According to the committee chairperson James Nyikal, the medical insurance scheme has faced significant operational challenges and financial constraints, resulting in a failure to meet its obligations to healthcare providers and beneficiaries.
This came out during deliberations with the top management of SHA and officials from the ministry of health who met in Mombasa on Thursday.
National Assembly committee on Health chairperson and Seme MP James Nyikal.
Photo credit: Jared Nyataya | Nation Media Group
Dr Nyikal noted that the turbulence facing SHA is as a result of low contributions that cannot match it’s expenses.
“They are barely getting what they can run on. The revenue versus the expenses is a big challenge,” he said.
According to the committee, SHA is collecting around Sh7.4 billion monthly but with operational costs of Sh7.2 billion as disclosed.
The challenge has been attributed to low remittance of premiums by Kenyans registered under the insurance scheme which now stands at 29 million registered members, but only 5 million people pay, leading to a massive funding gap.
The committee flagged that the revenue collected is barely enabling Kenya Kwanza administration to fully deliver on it’s Universal Health Coverage agenda.
However, the main impediment is the majority of registered persons who are from the informal sector as employed Kenyan only pay at a rate of 2.75 per cent of their monthly gross salary submitted by employers.
“They are now looking at other ways to help Kenyans pay which includes talking to SACCOs and other micro financing institutions to intervene. The people who are employed are now the main source of income for SHA and we are likely to face the issue of sustainability,” he added.
Despite the increasing number of registrations, the committee also heard that most of the people who volunteer to register for SHA is only when they get sick and in need of treatment but are not committed to paying their remittances.
He said that the ministry is now considering introducing a new flexible payment plan for Kenyans, by allowing them to pay in small amounts until they meet their revenue targets.
The ministry of health also raised alarm over the ballooning debts, seeking parliamentary assistance in allocation of an additional Sh5.3 billion to address the problem.
Dr Nyikal said that the government has also had to grapple with raising resources for the primary healthcare fund from the exchequer to sort out services at level 2 up to level 4 facilities.
As a result of these challenges, many Kenyans are forced to dig deep into their pockets to meet the expenses for medical services, despite SHA’s intention to provide universal health coverage.
On the alleged loss of Sh11 billion in fake claims, the committee said that it is examining the audit report by the auditor general and will advise the house on it’s findings.
“They did not have a proper claim system before and now they are putting it in place. We expect the issue of claims and debts to go down once that is done,” said Dr Nyikal.
The committee also noted that SHA defended itself saying no money is lost but is is experiencing a system glitch in payment of claims.
