State will only pay Sh10,000 for normal delivery under SHIF

The government will from next month pay Sh10,000 for any expectant woman giving birth through normal delivery and Sh34,200 for women undergoing a caesarean section, as per the benefits package.

The proposed benefits package of the long-awaited Social Health Insurance Fund (SHIF) administered by the Social Health Authority (SHA) is set to replace the NHIF in less than a month.

According to the proposal, women who have given birth normally will be covered for a maximum of two days and three days for caesarean section. This coverage will include pregnancy emergencies such as tranexamic acid and magnesium sulphate.

This means that mothers who want to give birth in private facilities may need to pay out of pocket, or hospitals may need to adjust their rates based on the rates of the Fund.

Read: This is how you will benefit under the new health plan

Under SHIF, services are funded by Primary Health Care (PHC) and SHIF funds, depending on where the service is accessed, and are available to all pregnant women and children, regardless of their contribution status at level 2 and 3 facilities. Antenatal and postnatal services will be covered on an outpatient basis at primary health care levels.

The cover also has other services including midwifery, operating theatre, recovery room, maternity ward, treatment rooms, meals and special diets, immunisation of the newborn, diagnostic laboratory tests, medical supplies and equipment.

Others are post-partum family planning, treatment of post-partum infections and haemorrhage, obstetric trauma, childbirth-related conditions and obstetric and neonatal complications.

Public hospitals charge between Sh10,000 and Sh28,000 for a normal delivery and Sh30,000 for a caesarean section with private facilities charging as much as Sh125,000 for a normal delivery and Sh270,000 for a caesarean section.

At Jacaranda Maternity Hospital, a normal delivery costs between Sh18,000 and Sh25,000, and a caesarean section between Sh41,000 and Sh55,000.  St. Mary's Mission Hospital charges between Sh10,000 and Sh13,000 for a normal delivery and between Sh20,000 and Sh25,000 for a caesarean section.

In reality, the services are supposed to be free. However, pregnant mothers are often asked to pay in cash, especially in emergencies. This has caused financial difficulties for them, despite having the NHIF, and has placed a significant economic strain on both mothers and their households.

Read: Kenyans get reprieve as SHIF contributions pushed to July

“I had stopped making payments on my NHIF card about seven months before I became pregnant. The penalty was significant, so I decided to pay in cash after giving birth. The hospital where I was going for my clinics informed me that I would only have to pay Sh10,000. To my surprise, I ended up paying Sh25,000. Additionally, I experienced some complications during the birth process, making the whole experience even more expensive and I had to pay for everything,” said Millicent Nyangaresi, a first-time mother who delivered at a level four hospital in Nairobi.

Private hospitals charge delivery depending on the care given. For example, Nairobi Hospital charged Sh125,000 for a normal delivery with a two-night stay, while Aga Khan University Hospital (AKUH) charged Sh108,550 for the same service.

At Nairobi Hospital, a caesarean section costs Sh240,000 for a three-day stay, while at AKUH, the cost ranged from Sh206,850 in the general ward to up to Sh270,900 in a private room for the same period.

Coptic charges up to Sh35,000 for normal delivery in a ward bed for a single night and up to Sh65,000 for a caesarean section for two nights.  

“One thing is that private hospitals take good care of the mother in terms of food, gynaecologists have a listening ear and are never in a hurry, the close monitoring of a patient's healing process and the baby’s progress checking are top-notch,” says Marion, a mother of two.

According to data from the Ministry of Health, the number of Kenyans delivering their babies by caesarean section has exceeded the World Health Organization's (WHO) recommended limit. The average C-section rate for Africa is estimated at around 9.2 per cent.

Read: No more Linda Mama? What you need to know about SHIF

SHIF's maternity services will be available to current members and their dependents.

Additionally, Anti-D will only be provided to rhesus-negative mothers with prior authorisation. The anti-D immunoglobulin neutralises any Rhesus factor D (RhD) positive antigens that may have entered the mother's blood during pregnancy. 

After childbirth, a woman who was previously considered a dependant must upgrade to a principal member to ensure continued coverage for herself and the baby, as is the case with NHIF.

Maternal health remains a major challenge in Kenya, with a maternal mortality ratio of 355 deaths per 100,000 live births, according to the United Nations Population Fund (UNFPA). 

This puts the country at risk of not meeting its commitment to reduce maternal deaths to less than 70 per 100,000 live births.

The country has implemented health sector reforms to improve maternal healthcare. In 2013, the government introduced the Free Maternity Policy, providing free maternal health services in the public sector.

In 2017, the management of the programme was transferred to the National Health Insurance Fund (NHIF), leading to the introduction of 'Linda Mama', which expanded services and benefits.

The programme was rolled out in three phases. The first phase began in April 2017, during which private for-profit and faith-based health facilities were contracted by NHIF to provide maternity services.

The second phase began in July 2017, when all public healthcare facilities were also contracted to provide delivery services.

Finally, the third phase was launched in March 2018, extending the benefit package to include antenatal care (ANC) and postnatal care (PNC) in contracted public, private, and faith-based healthcare facilities.