The newly introduced Social Health Insurance Act of 2023 is anticipated to have an impact on existing healthcare frameworks like Linda Mama and Edu Afya.
This new legislation, known as SHIF, will supersede the National Health Insurance Fund (NHIF), with deductions of 2.75% from citizens’ salaries scheduled to begin this month.
According to Health Cabinet Secretary Susan Nakhumicha, SHIF comes as a reaction to the pressing need for accountability, a sentiment that the government has supported.
The Social Health Insurance (General) Regulations, 2024 has repealed NHIF and established three new funds: the Primary Healthcare Fund, the Social Health Insurance Fund, and the Emergency, Chronic and Critical Illness Fund.
The Primary Healthcare Fund will cover services at Levels 1 through 3 hospitals, the Social Health Insurance Fund will pay for services at Levels 4 through 6, and so on. The Emergency, Chronic, and Critical Illness Fund will pay for services once social health insurance is exhausted.
Last year, the government terminated the insurance coverage provided by the EduAfya program for students, leading to significant protests from parents and students alike.
To this effect, the Health CS announced that the allocated KES 4.6 billion for the program would be redirected to the Primary Healthcare Fund, which will now include coverage for students and their families.
The EduAfya Medical Scheme became effective in May 2018 following a directive from former President Uhuru Kenyatta and it covered learners in public secondary schools across the country. Through the cover, the government paid a premium of KES 1,350 per student for over 3.4 million learners.
As she explained why the EduAfya Medical Scheme has to be phased out, Nakhumicha said that since it makes no sense to insure a student who comes from a family but leaves the rest of the household uninsured, all students will be covered under their households.
Subsequently, the Social Health Insurance Fund, according to CS Nakhumicha will cover maternal and child clinics previously done by the Linda Mama programme.
Former President Uhuru started the free maternity initiative dubbed Linda Mama in 2016. It was a publicly funded healthcare scheme launched by NHIF.
The former President removed all user fees for delivery at state healthcare facilities, and free maternity services were implemented. The Ministry of Health would then compensate medical facilities for the money they had lost.
However, because the ministry lacked a beneficiary registration to validate provider claims, this structure was marred by inefficiencies and fraud.
Other services covered by SHIF include; screening, drug rehabilitation, mental health support, physiotherapy, CT scans, MRI and PET scans, X-rays, brachytherapy, outpatient and inpatient services, HIV testing, cancer screening, family planning, surgeries, emergencies, including ambulance services, cardiac arrest, accidents and even transplant procedures.
