On July 1st, 2024, Kenya was expected to usher in a new healthcare financing model, the Social Health Insurance Fund (SHIF). The imminent transition from the National Health Insurance Fund (NHIF) to the Social Health Insurance Fund (SHIF) promises to revolutionize healthcare to realize the dream of universal Health Coverage (UHC), a key pillar of the country’s development agenda and an integral part of the Kenya Kwanza government’s Bottom-Up Economic Transformation Agenda (BETA).
However, a cloud of uncertainty had been hanging over the implementation of the new health plan, with citizens indicating that July 1st was too soon and that they were not ready for the transition into SHIF.
The Promise
SHIF represents a shift from voluntary to compulsory health insurance, aligning with Article 43 of the Kenyan Constitution, which guarantees every citizen the right to the highest attainable standard of health. It’s designed to overcome the challenges that plagued the NHIF since its inception in 1966, such as limited coverage, inefficiencies in claims processing, and allegations of corruption. These longstanding issues have significantly hampered Kenya’s progress toward UHC, leaving a substantial portion of the population vulnerable to catastrophic health expenditures.
SHIF aims to change this by transforming Kenya’s healthcare system and dramatically expanding coverage, especially benefiting informal sector workers and economically vulnerable groups. Say goodbye to the old NHIF and hello to the new SHIF. But what does SHIF bring to the table?
- Mandatory universal coverage for all Kenyans
- Improved efficiency and quality of health services
- Reduced out-of-pocket expenses for citizens
- Equitable access, with a focus on vulnerable populations
- Expanded coverage for informal sector workers
- Access to a broader range of healthcare services
- Increased funding for the overall healthcare system
- Emphasis on preventive care and better chronic illness management
However, as with any major systemic change, the success of SHIF will depend on effective implementation and the ability to overcome the challenges that have hindered previous efforts at healthcare reform. While it appears to be a progressive move on paper, its true impact remains to be seen.
The Reality Check: Findings from “Shifting to SHIF”
As we approach the roll-out of this major health reform, a recent Sauti za Wananchi report “Shifting to SHIF: Time for a Health Check” by Twaweza East Africa has shed light on critical aspects of this transition, revealing a stark contrast between promise and reality.
The report’s findings paint a sobering picture of the current state of health insurance in Kenya. Only half of Kenyan citizens (53%) currently have some form of health insurance, a statistic that underscores the magnitude of the challenge in achieving universal coverage. This raises critical questions about the feasibility of mandating insurance for all Kenyans, particularly given the large informal sector in the country.
While NHIF members appreciate the quality and affordable services provided (71% of members), significant challenges remain. Nearly half (49%) of NHIF members complain that it doesn’t cover all ailments, and over a third (36%) are frustrated that they can only attend specific hospitals.
The report also highlights persistent issues in the current healthcare system that SHIF must address. Citizens overwhelmingly point to two main challenges: The unavailability of medicines at health facilities (cited by 46% of respondents) and the high cost of healthcare (mentioned by 23% of respondents). These are not new problems, but they are ones that SHIF must tackle head-on to succeed where NHIF has struggled. The transition to SHIF represents an opportunity to address these longstanding issues and truly transform healthcare access for all Kenyans.
The Information Gap
One of the most glaring issues highlighted during the launch is the significant information gap surrounding SHIF. Despite the imminent rollout, many Kenyans remain in the dark about what SHIF entails, how it will affect them, and what they need to do to comply. This lack of awareness stands in stark contrast to Article 35 of our constitution, which guarantees citizens the right to access information held by the State.
Despite attracting health sector stakeholders, many expressed a pressing need to learn more about SHIF. This information gap is not merely a matter of public relations; it poses a significant threat to the success of the SHIF launch and the subsequent implementation of SHIF. Without proper understanding and buy-in from the public, the transition risks facing resistance, non-compliance, and ultimately, failure to achieve its objectives.
Technical Readiness
Adding to the concerns about public awareness are serious questions about the technical readiness for the SHIF rollout. With less than a week to go before the July 1st launch date, there were grave concerns about the readiness of the digital infrastructure necessary to support SHIF. The SHIF transition committee stated in its report that a pilot run of the ICT system revealed it was not ready less than a week before the scheduled switchover. The team suggested that the Ministry of Health should consider continuing with the NHIF and withdrawing the regulations already issued for the new system. The report by the SHIF transition committee highlights apprehensions about the integration of digital health systems and the security of medical records.
In an age where data breaches are increasingly common and privacy concerns are paramount, these issues cannot be overlooked. The success of SHIF will depend heavily on a robust, secure, and efficient digital infrastructure. Any shortcomings in this area could undermine public trust and the overall effectiveness of the new system.
The Funding Conundrum
Perhaps one of the most contentious issues surrounding the SHIF rollout is the question of funding. Dr. Brian Lishenga, Chair of the Rural and Urban Private Hospitals Association of Kenya, voiced significant concerns about the underfunding of the public healthcare system. He highlighted a substantial shortfall in the National Health Insurance Fund (NHIF) and criticized the proposed budget for primary healthcare as being significantly less than for other health facilities covered under level 4 and 5 hospitals.
This funding gap is particularly worrying given the ambitious scope of SHIF. The new system promises comprehensive coverage, including everything from outpatient services to overseas treatment. However, without adequate funding, these promises risk remaining just that – promises. There are legitimate fears that underfunding could lead to a deterioration in the quality of care, particularly at lower-level facilities that serve the majority of Kenyans.
Have we learned any Lessons from the Past?
The push for a rapid implementation of SHIF bears an uncomfortable resemblance to the rushed rollout of the Competency-Based Curriculum (CBC) in 2017. In both cases, political considerations seem to be driving the timeline more than practical readiness. This raises the question: Are we witnessing history repeat itself, where political expediency trumps careful planning and integration?
The potential consequences of a rushed implementation cannot be overstated. A poorly executed rollout could erode public trust, strain an already burdened healthcare system, and ultimately set back Kenya’s progress toward UHC.
A Call for Pause and Reflection
Given these many challenges, it’s clear that the July 1st rollout date was overly ambitious. What Kenya needs now is not a hasty implementation, but a thoughtful, inclusive approach to healthcare reform. Here’s what we should consider:
- Delay the Rollout: Allow for proper system testing, stakeholder engagement, and public education. A few months of delay could make the difference between success and failure.
- Comprehensive Public Education Campaign: Leverage media houses, community health workers, and digital platforms to launch a widespread awareness campaign. The Twaweza report shows that almost 70% of respondents were aware of the role of community health workers, indicating that targeted information campaigns can be effective.
- Genuine Public Participation: Engage in meaningful public participation, as mandated by our constitution. The Twaweza report highlights the importance of incorporating citizen perspectives in policy discussions. This isn’t just about compliance; it’s about creating a system that truly meets the needs of Kenyans.
- Review and Revise the Benefits Package: Ensure that the SHIF benefits package truly serves all Kenyans, addressing the concerns raised about potential negative impacts on lower-level hospitals. This may require a phased approach to implementation, starting with essential services and gradually expanding coverage.
- Invest in Capacity Building: Healthcare workers, especially at the community level, will be crucial to the success of SHIF. Significant investment in training and support for these frontline workers is essential.
- Address Primary Healthcare Funding: As highlighted by Dr. Lishenga, the underfunding of primary healthcare is a critical issue. A successful SHIF must have a strong foundation in primary care, which requires adequate funding and support.
- Strengthen Digital Infrastructure: Invest in robust, secure digital systems to support SHIF. This includes not just the systems for registration and claims processing, but also measures to protect patient data and ensure seamless integration across different levels of care.
- Develop Clear Accountability Measures: Establish transparent mechanisms for oversight and accountability. This includes regular reporting on key performance indicators, independent audits, and clear channels for public feedback and grievance redressal.
The Path Forward
Health is not just a constitutional right; it’s the cornerstone of our nation’s healthy future. As we embrace this significant change, let’s ensure we get it right. SHIF can potentially transform healthcare in Kenya, but only if implemented with careful consideration, transparency, and true public engagement. The coming days will be crucial. Will our leaders heed the calls for a more measured approach, or will political considerations push us into uncharted waters? As citizens, we have to stay informed, ask questions, and demand a healthcare system that truly serves all Kenyans.
We must also recognize that the transition to SHIF is not just a matter of changing systems; it represents a fundamental shift in how we approach healthcare financing as a nation. It requires a change in mindset, from viewing health insurance as an option to seeing it as a civic responsibility and a fundamental right.
Moreover, the success of SHIF will depend not just on government action, but on the active participation of all stakeholders. Healthcare providers must be ready to adapt and capacity build to new systems and processes. And individual citizens must be prepared to engage with the system, understanding both their rights and responsibilities.
We must also keep our eyes on the ultimate goal: improving the health and well-being of all Kenyans. SHIF is not an end in itself, but a means to achieve better health outcomes, reduce financial hardship due to healthcare costs, and ultimately, contribute to the socio-economic development of our nation. The clock is ticking.
July 1st may have been too soon for the rollout of SHIF, but with the right approach, we can ensure that when it does roll out, it will be a system we can all believe in and benefit from. Let’s learn from the lessons of the past, address the concerns raised in the “Shifting to SHIF” report, and work together towards a healthier future for all Kenyans.
The health of our nation depends on getting this right. Let’s rise to the occasion and create a healthcare system that truly serves all Kenyans, now and for generations.
By Filbert Mbugua – A Consultant Youth Researcher at Twaweza East Africa and can be contacted via consultantfm@twaweza.org
