Amid a transition from the longstanding 57-year-old National Health Insurance Fund (NHIF) to the Social Health Authority (SHA), there is widespread confusion, uncertainties and queries surrounding this shift.
What next? What is the significance of the three different funds? In this exclusive interview, Nation.Africa recently engaged the SHA Chairman, Dr Timothy Olweny on the intricacies of this transition.
How is the transition from NHIF to SHA?
So far so good. The work started with the preliminary steps being done and now, with the successful passage of bills by Parliament and presidential assent, we have reached a point where we have published the regulations. Once this stage is completed, the legislation committee in Parliament will review the proposed changes. Following the committee's approval and gazetting, we will proceed with the registration process, allowing individuals to make contributions and facilitating the implementation of the new system.
Does it mean that the contributions being done right now are not really under SHA?
Yes, that's correct. The contributions being made are still under the previous regime, as the transition to the SHA is in progress. Although SHA owns all the assets and liabilities, the current contributions are governed by the existing regulations. The complexity arises from the need to finalise and implement the new set of regulations that will govern contributions and other aspects under SHA. Once these regulations are sorted out, the system will officially operate under the framework of SHA.
What is the difference between SHA and SHIF?
Before we had NHIF and was running one programme. Based on the challenges that we had in our healthcare system, it became prudent for us to expand the scope. We realised that most people are paying for healthcare out of pocket as insurance penetration is still low. That is why we formed this SHA, an entity that has three distinct funds, each with a specific mandate.
The Primary Healthcare Fund places a strong emphasis on preventative and promotive healthcare measures. This encompasses services like screening for non-communicable diseases, post-natal care, and patient education.
Then we have the SHIF, and Emergency and Chronic Illness Fund, catering to immediate healthcare needs during emergencies and providing long-term support for individuals with chronic illnesses.
So, who is eligible for what fund?
Eligibility for the different funds under the Social Health Insurance (SHA) framework is determined by the level of care and the nature of the healthcare services required. There is a primary care fund, and this was instituted after noticing that the NHIF financing was concentrating on curative care rather than preventive and promotion of wellness. Now we are starting with preventative and promoting wellness at the low levels of the healthcare system -levels one, two and three. Level one is being undertaken by CHPS, with the other levels being undertaken at the healthcare centres and dispensaries. These are financed by the exchequer and do not necessitate direct payment. Registration with SHIF is all that is required to access these services.
On the other hand, SHIF, encompasses levels four, five and six, where contributors are required to make regular contributions to access care. For those in informal employment, the contributions will be annual, unlike those who are in formal employment and are expected to contribute monthly. Penalties for non-payment are proposed to be two percent, cumulatively based on the period of non-payment.
Notably, if a member exhausts their funds within SHIF, individuals will be automatically transferred to the Emergency and Chronic Illness Fund without an additional payment requirement.
Membership contributions are essential for access to this fund, except for emergency care, which is funded by the exchequer. By emergencies, I mean conditions that if no intervention is made, one may lose their lives.
Will there be additional payments like with NHIF or are we telling Kenyans that moving forward, if you have paid up, you will receive treatment?... Are we done with harambees?
Moving forward, the SHA system aims to provide a more streamlined and predictable healthcare financing model for Kenyans. Once individuals are paid-up members of the system, the emphasis is on ensuring that they receive the necessary treatment without the need for additional payments, with the intention being to move away from the traditional reliance on harambees and create a comprehensive benefits package. This package outlines the entitlements individuals can expect, with, for example, a fixed amount, for specific medical care. While the actual implementation details, including pricing and specific benefits, will be determined after thorough public participation, gazettement of regulations, and finalising collection figures, the overarching goal is to establish a system where pre-paid contributions result in access to essential healthcare services without the necessity of additional payments.
Will those who had registered with NHIF require to register again?
The registration will be done afresh for everybody, and we are hoping to do it over a 90-day period. Unlike NHIF, which was individual-based, SHA operates on a household basis, with a minimum contribution of Sh300 per household. For those in formal employment, the registration process is straightforward as their numbers are easily determined. However, for indigent individuals such as street children, or those in children’s homes, the government will cover their contributions. The registration process involves aggregating household income and after registering, one will be able to immediately access healthcare services.
How much are you planning to raise every year, and where will the money be banked?
On the financial projections for SHIF, we were hoping to raise 150 billion while the Primary Healthcare Fund and the Emergency Care Fund aim to raise 50 billion and 70 billion, respectively, so about 275 billion per year. The money will be banked in the account of SHA once we set them up.
Are you worried that the salaried lot is being forced to carry a huge burden on behalf of the hustlers?
Ideally, SHIF is not supposed to be equal but equitable, that’s the design of the contribution’s architecture and so, contributions are supposed to be progressive; those earning more should pay more because in the previous fund, you’d find those earning less paying more to access healthcare services.
There is controversy over the suggestion that defaulters and non-payers will not access government services. What’s the SHA position?
We need to be able to onboard everyone because that’s the way Universal Health Coverage (UHC) is supposed to work. In the past, we had voluntary contributors and contributions were erratic, sometimes only when a need arises. We cannot have that in the new fund. That is why we need a pool of funds and everyone in it. I know it sounds distasteful but what we need is input from people to tell us how else we can achieve UHC because without the numbers, the system will not work.
How long will it take for those in informal employment to be assessed?
It will take a while, but this will be in a progressive manner. There is an automated testing tool that will be used to gauge the amount a particular household should pay. Contributions will kick in after regulations are done, and I am estimating that this will tentatively, be in March. On this new fund, we are not going to have an enhanced scheme—what is provided is standard and those who want enhanced benefits can do it through other forms such as private insurance. All these are modalities that we will discuss during the public participation.
Will contributors be limited to specific healthcare facilities?
No, we aim to make this like a digital superhighway where your data is shared across the board so that individuals can access healthcare in any part of the country.