Let’s embrace disease diagnosis for evidence-based treatment

As the country transitions from National Health Insurance Fund (NHIF) to Social Health Authority (SHA), healthcare in Kenya is embarking on an evolutionary journey.

The SHA introduces three significant Funds that aim to fulfil healthcare needs of Kenyans: Primary Health Care Fund, Social Health Insurance Fund (SHIF) and the Emergency Chronic and Critical Illnesses Fund.

One of the most complex demands amongst many Kenyans while seeking healthcare is proper diagnosis before treatment. Due to our health financing models and the high cost associated with diagnostic procedures, many families have often skipped this stage and desperately resorted to self-prescribed medications. They buy medications over the counter or sometimes abandon the process altogether when sent to the medical laboratory for investigations.

The new funding model re-establishes a fundamental principle of medicine: definitive diagnosis precedes treatment. Such an approach will ensure Kenyans access evidence-based care, effectively bridging the gap in healthcare that has plagued the nation for years due to economic constraints. According to the regulations, Laboratory services will be available free for all at Level 2-3 facilities.

All those registered and paid up under SHIF will also enjoy insured diagnostic services in Level 4-6. However, the professionals are recommending that specialised laboratory services by stand-alone laboratories be considered under the benefits package of SHIF.

Early detection and prevention

The concept behind Primary Health Care Fund lies in offering fundamental healthcare services, which include primary diagnosis. This initiative stresses the importance of early detection and prevention strategies, thus enabling individuals to nip potential health hazards in the bud. Over the years, many Kenyans have lost their loved ones following late diagnosis caused by lack of information and inability to fund definitive diagnosis.

Secondly, the SHIF is designed to offer enhanced financial protection to Kenyan families, some of whom will pay a monthly premium of Sh300 only from the current Sh500. This will empower majority of Kenyans to seek professional healthcare with comprehensive diagnosis without worrying about the financial burden.

Similar services will be availed to salaried and non-salaried households, who will pay a premium of 2.75 per cent of their monthly and annual incomes respectively.

The Emergency, Chronic and Critical Illnesses Fund targets a unique demographic that is often the most destitute: Those suffering from chronic and critical illnesses. This fund will intervene directly to facilitate diagnostic services and critical care with a more enhanced health cover which will be accessible to all.

The government’s move to prioritise diagnosis within this new health financing model will improve national health standards and access to evidence-based treatment which is a significant game changer in the healthcare system.

Indeed, establishing a model that heavily supports diagnostic analyses before treatment will revolutionise treatment success rate. The focus on establishing a more robust institution such as the SHA will augment the country’s disease surveillance systems and ensure universal health coverage (UHC) and set Kenya on the path to accomplishing the healthcare facet of the Sustainable Development Goals.

The evolution from NHIF to SHA ushers hope of a brighter, healthier future for Kenya and ensures healthcare is not confined to the privileged but is a universal right for every Kenyan.

That should birth an ongoing relentless pursuit of continual improvement in the delivery, access and affordability of health services across the nation.

Dr Mutwiri, PhD, medicine lecturer at Kenya Methodist University, is the Kenya Medical Laboratory Technicians and Technologist Board chairman. [email protected].