Social Health Authority Chairman Dr Timothy Olweny.
What is changing in the provision of social health insurance?
The government is replacing the 58-year-old National Health Insurance Fund (NHIF) with the Social Health Authority (SHA) that will be managing three funds to take care of primary healthcare, emergency, health services and chronic and critical illnesses.
What is the progress in the shift?
The Social Health Insurance Act, 2023 that provides for the creation of SHA was gazetted in November. It allows up to one year transition from NHIF.
The State on January 26 published the draft Social Health Insurance (General) Regulations, 2024 that are supposed to operationalise the new Act. The draft is under public participation until February 9.
Is it a shift from NHIF to SHA or SHIF?
The SHA is replacing the NHIF. Under SHA, there are going to be three funds: Primary Healthcare Fund, Social Health Insurance Fund (SHIF) and Emergency, Chronic and Critical Illness Fund.
What is changing in terms of contributions?
Under NHIF, it has been compulsory for salaried people to contribute between Sh150 and Sh1,700 monthly, depending on income. Those in the informal sector have been contributing Sh500 per month, with this being only for those who want this cover.
Under SHA, the contributions will be compulsory for all adults, with a few exemptions such as full-time students who are under 25 years. Contributions are going to be 2.75 percent of gross salary for the salaried and 2.75 percent gross income for those not in salaried employment, subject to a minimum of Sh300.
How will SHA know the monthly income of those not in salaried work?
The draft regulations allow SHA to collect data from households for what it calls proxy means testing. SHA will use this instrument developed by the Ministry of Health in collaboration with the Ministry responsible for social protection and the county governments.
The data will be based on aspects including housing characteristics, access to basic services and household composition and characteristics.
The data will be used to estimate the household income for the purposes of the premiums. The means testing reviews will be periodic.
What happens if one cannot afford to contribute?
SHA will use the means testing instrument to identify the indigent households that require financial assistance and for whom the national or county government will pay for them.
When are the new deductions setting in?
The Ministry of Health has indicated that it intends to roll it out in February once public participation is concluded. Changes may or may not happen at the public participation stage.
Do NHIF members automatically become SHA members?
No. There will be a new registration with SHA. Even hospitals under NHIF will have to apply afresh to be SHA-accredited.
Within 90 days upon the coming into force of these regulations, every person resident in Kenya will have to apply for SHA membership and get a social health insurance number.
A contributor will provide a list of beneficiaries.
Who is going to lead the transition?
The Health Cabinet Secretary on January 25 appointed a 10-member transition committee. Its mandate is for six months. The committee will develop a roadmap for winding up of NHIF and transfer assets and liabilities to SHA.
The SHA board will be expected to competitively recruit and appoint its staff subject to the approved staff establishment. However, priority will be given to qualified NHIF staff.
What will be the services on the enhanced contributions?
This is not clear yet. The draft Social Health Insurance (General) Regulations, 2024 provides that the Health CS will establish a Benefits Package and Tariffs Advisory Panel to advise on the benefits.
Some of the factors the panel will consider in designing the benefits package include burden of disease, incidence or occurrence of diseases, the population, cost-effectiveness and budgetary impact and affordability.
The proposed tariff will have to undergo stakeholders’ engagement and be recommended to the Health CS for approval and gazettement before it can set in.
Any legal hurdles for the plan?
Yes. The Court of Appeal, with caveats, lifted the High Court orders that had stopped the implementation of Social Health Insurance Act, 2023, The Primary Health Care Act, 2023 and The Digital Health Act, 2023.
The provision making registration and contribution a precondition for dealing with or accessing public services from the national and county governments or their entities is still suspended and so is the one that requires contributions to be up to date for one to access other public services.
Also still suspended is the provision obligating every Kenyan to be uniquely identified for purposes of provision of health services. The three provisions await the hearing and determination of the government's appeal.
