Digitization of Social Health Insurance Fund

Health Cabinet Secretary Susan Nakhumicha has announced that the Social Health Insurance Fund (SHIF) is now 99 percent digitized, marking a significant transition from the National Health Insurance Fund (NHIF). The move is aimed at ensuring verifiable data capture and preventing issues such as double billing and fraudulent claims, which were prevalent under the NHIF system.
“Typing errors are things that can easily be taken care of, and that is why SHIF is 99% digitized. There will be very few manual interventions in the new system,” stated Nakhumicha. The digitization initiative reflects the government’s commitment to leveraging technology for improved health service delivery and accountability.

Nakhumicha emphasized that no private insurance company has been outsourced for claims management. Instead, SHIF will utilize a claims management system owned by the State Health Authority (SHA) to ensure that the management of claims remains under government oversight. This approach is designed to maintain transparency and control over the health insurance system.

Acknowledging the numerous loopholes that plagued the NHIF system over its 50-year existence, Nakhumicha noted that the government has conducted an audit to verify the services provided by each facility. “We must use the existing institutions to ensure a proper audit of facilities is done for them to be enrolled to Social Health Insurance as a service provider. For example, we have heard cases where a facility claimed to have done surgeries yet they do not have a theatre, that is fraud,” she said.

Under the new health model, the SHIF will offer up to Ksh11,200 for normal deliveries and Ksh32,200 for caesarian deliveries under the Linda program, significantly higher than the previous NHIF reimbursements of Ksh5,000 and Ksh17,000, respectively. This enhancement aims to provide better financial support for essential health services.

Nakhumicha assured that the government will cover premiums for individuals who are unable to generate income, including people living with disabilities and the elderly. This inclusive approach ensures that vulnerable populations receive the necessary health coverage.

To ensure a smooth transition to SHIF, a suitability test will be conducted for NHIF staff to assess their expertise and experience. “We need to have the right people doing the right job. We are going to have a suitability test of the staff within NHIF as we transit them to see whether they have the expertise and experience to run the system,” Nakhumicha explained.

The digitization of SHIF represents a pivotal step towards a more efficient and transparent health insurance system in Kenya, promising improved service delivery and enhanced trust in the country’s healthcare infrastructure.