Kenyans will no longer access healthcare services under the National Health Insurance Fund (NHIF) starting October 1, 2024, as the government transitions to the new Social Health Insurance Fund (SHIF). The NHIF, which has been the cornerstone of public health insurance in Kenya for decades, will cease to operate, marking a significant shift in how healthcare services are financed and accessed.
In a statement released on Sunday, NHIF CEO Elijah Wachira confirmed that the new health scheme, SHIF, will be managed by the Social Health Authority (SHA), which will oversee all operations under the new regime. The benefits under SHIF will come into full effect on October 1, and the transition will require employers, both in the public and private sectors, to register their staff before this date to avoid any disruptions in coverage.
Transition to SHIF
To facilitate the transition, Wachira explained that payments made before October 9, 2024, will still be credited to NHIF. However, any payments made after that date will go directly to SHA and be credited under the SHIF scheme. Employers are encouraged to create accounts on the SHA employer portal via https://sha.go.ke/ to register and manage their employees’ contributions.
The transition requires employers to enter their employees’ details into the new system, where contributions will be set at 2.75% of an employee’s monthly salary. This move aligns with the government’s goal of broadening healthcare coverage and ensuring all Kenyans have access to affordable, quality healthcare.
Benefits and Coverage under SHIF
Health Cabinet Secretary Deborah Barasa has been at the forefront of outlining the comprehensive benefits package offered by SHIF. One of the critical features of the new scheme is the enhancement of the Linda Mama program, which will now cover more services for expectant mothers. The Linda Mama program, credited with reducing maternal mortality in Kenya, will see increased funding to sustain these gains. Under SHIF, mothers will now be covered for normal deliveries at Ksh.10,000 and Ksh.30,000 for caesarean sections. This is a significant increase from the previous rates, ensuring broader access to maternal health services.
In addition to maternal health, SHIF will provide improved coverage for cancer treatment. Cancer patients will be eligible for up to Ksh.400,000 for oncological services. This move is seen as a direct response to the increasing cancer burden in Kenya, where access to affordable cancer care has been a significant challenge for many families.
Patients with chronic conditions such as diabetes and hypertension will also benefit from SHIF. Those seeking outpatient services for diabetes in Level 4 to Level 6 facilities will receive coverage of up to Ksh.4,300 annually, while those with hypertension will be covered up to Ksh.2,850. Patients suffering from sickle cell anemia will have coverage of up to Ksh.6,800 per year.
Inpatient and Specialized Services
The SHIF scheme also aims to improve access to inpatient services in higher-level hospitals. According to the Ministry of Health, inpatient services in Level 4 to Level 6 hospitals will come with defined tariffs. Level 4 facilities will charge Ksh.3,360 per day, Level 5 facilities Ksh.3,920, and Level 6 facilities Ksh.4,480, with coverage allowing for up to 180 days of admission per household annually. This is a significant step towards providing more affordable care for severe illnesses and extended hospital stays.
Kidney failure management, one of the costliest conditions to treat, will also receive substantial coverage under SHIF. The scheme will provide Ksh.10,650 per session for hemodialysis and hemodiafiltration services at Level 3 to Level 6 hospitals. Patients who require peritoneal dialysis will have access to a monthly cover of Ksh.85,200, helping ease the financial burden of long-term kidney treatment.
Enhancing Healthcare for All
The introduction of SHIF comes amid rising healthcare costs and growing demand for more equitable access to quality services. Health CS Deborah Barasa emphasized the government’s commitment to addressing healthcare challenges, particularly those affecting vulnerable groups like pregnant mothers, cancer patients, and those with chronic conditions. She highlighted that SHIF tariffs have been carefully structured to ensure that all Kenyans, regardless of income level, can benefit from the new scheme.
As the country fully transitions to SHIF, Kenyans are encouraged to familiarize themselves with the new system and ensure that their contributions are up to date. Employers play a critical role in this process, with the Ministry of Health urging them to register their employees on the SHA platform before October 1, 2024. With SHIF’s comprehensive coverage and revised tariffs, the government aims to provide universal health coverage and make healthcare services more accessible and affordable for all.
The move marks a new chapter in Kenya’s healthcare system, aiming to deliver sustainable, long-term benefits to millions of Kenyans.
