All systems are ready for the rollout of the Social Health Authority (SHA) on October 1, the government said, even as various stakeholders poked holes in the readiness of the new system.
They spoke during the national validation workshop on the SHA benefit package and tariffs on Friday, August 30, when they expressed reservations about, among other things, payment modalities.
Under the new plan, the Social Health Insurance Fund's (SHIF) outpatient services will be accessible to registered members at a tariff cost of Sh700 (for asthma), Sh4300 (diabetes) and Sh6800 (sickle cell disease), with a one-time access limit per person per year.
On the other hand, inpatient services, which include the management of diseases and conditions during hospitalisation, cost between Sh3360 and Sh4480 and are limited to 180 days per household. These services are available at level 2 facilities and above.
The Primary Healthcare Fund will only benefit registered members and services will be available at level 2, 3 and selected level 4 health facilities at a tariff cost of Sh900 per person per year.
Kenyans will also have access to accident and emergency services under the scheme, including resuscitation and stabilisation for seizures, snake venom and rabies. These services will be available to all Kenyans at level 2 to level 6 facilities, regardless of registration or premium payment status.
However, cosmetic surgery or complications arising from such surgery, weight management drugs, nutritional supplements and IVF assisted fertility treatment are excluded from the benefits.
While Kenyans will also benefit from ambulance evacuation services regardless of their registration or payment status, stakeholders were concerned about some of the tariff costs such as Abdominoperineeal Resection (APR-tumour), which they argue takes a lot of time and requires specialisation but costs only Sh134,400.
In the new scheme, vertically financed programs, also known as vertical funding initiatives, that focus on targeting specific diseases or health issues rather than integrating into broader health systems such as ARVs, antimalarials, anti TBs and associated tests, and family planning will be provided at public facilities and faith-based and private facilities.
The tariffs, which the government says have gone through various stages such as public participation for feedback and stakeholder engagement, indicate that the scheme is ready to go.
Health Cabinet Secretary Deborah Barasa said the validation of tariffs for services under the Social Health Insurance (SHI) Act was crucial as "it is the next step towards access to services under the Social Health Authority", which begins in October.
“This is the first time Kenya, and more so, this Government is publishing tariffs to the benefits, allowing all Kenyans to know the amounts that will be paid by the Social Health Authority for specific ailments at any given time. This fosters accountability, transparency, and ultimately helps with cost containment and sustainability,” the CS added, as she urged Kenyans to register as members of SHA.
According to Health PS Mary Muthoni, the validation was a pivotal moment and a significant step towards Universal Health Coverage (UHC).
“This validation is not merely procedural,” assured Health PS Mary Muthoni.
“It signifies our collective commitment to ensuring that all Kenyans have access to quality healthcare without financial burden.”
However, the chairperson of County Executive Committees (CEC) health caucus Michael Kibiwott warned the SHA board from promising Kenyans as he urged the state to iron out the issues of delayed payment that was experienced with defunct NHIF.
“Be careful about promises to Kenyans,” Mr Kibiwott said.
Mr Samuel Mwenda of the Kenya Faith Based Health Services consortium said: “Compared to the other years, this year, there were a lot more consultations. We do know that we did not get everything that we requested…There are issues around implants and maternal health but we have requested that in this period that we are starting on. That maybe after a year or six months we can actually revisit the areas that have been underfunded because of financial constraints."
Mr Mwenda said the faith-based hospitals were concerned about the co-payment model of the new health plan.
“We are very keen to make sure that SHA, whenever you have resources, you are paying at least to recover the cost so that for us once we treat the patient, we don’t have to discuss with the patient about adding more money… And for that reason, because we are not going to start off by charging or co-charging our patients, we would ask that we do not sign a two-year contract. [instead] we do one year and we pick the lessons that we have learnt with that period and see if the economic situation in the country would have improved some of the packages that we have raised issues about,” said Mr Mwenda.
Nominated Senator Esther Okenyuri urged the ministry to address cases where registered members still do not have access to healthcare.
“Kenyans cannot access NHIF services and have to pay in cash. I do not know what the ministry is going to do about that. The other concern is the issue of pending NHIF reimbursement. Facilities are suffering because of that issue. We are asking the ministry to look into this issue as well," said Ms Okenyuri.
