SHA Guarantees Continued Access to Dialysis, Cancer, and Maternity Care Under New Health Plan

On October 1, 2024, Kenya entered a new era of healthcare provision with the transition from the National Health Insurance Fund (NHIF) to the newly established Social Health Authority (SHA). This shift, announced by the Kenyan government, is designed to align with the country’s long-term vision of achieving universal healthcare coverage, ensuring that all citizens, irrespective of socioeconomic background, can access affordable and quality healthcare.

The introduction of SHA comes with a suite of enhanced benefits, an emphasis on preventive care, and a commitment to providing Kenyans with uninterrupted access to healthcare services during the transition. The SHA has reassured citizens that no services will be disrupted, alleviating concerns that the new medical scheme might cause delays or gaps in care, especially for patients requiring critical medical services.

SHA Takes Charge: Healthcare Access Assured Amid Transition

SHA’s establishment marks the end of the NHIF, which had been the primary public healthcare insurer in Kenya for the past 58 years. SHA is tasked with offering improved benefits and providing a more efficient, equitable, and affordable healthcare system. While the transition has sparked questions and uncertainty among Kenyans, SHA officials, alongside the Ministry of Health, have been quick to calm any fears of service disruptions.

In a statement issued ahead of the rollout, Elijah Wachira, the Acting CEO of SHA, instructed all contracted healthcare providers, particularly those at levels 2 and 3, to continue delivering critical services to patients. These services include dialysis, cancer treatment, and maternity care. This directive underscores the government’s commitment to ensuring no patient is left without vital care during the transition to SHA.

“Further to my earlier letter on the above subject matter, kindly further note that no member will be denied Dialysis and Cancer services, Maternity services should not be denied in KEPH (Kenya Essential Package of Health) level 2 and 3, and Active Managed schemes should continue accessing services,” Wachira’s statement read.

The Acting CEO’s communication, coupled with SHA’s engagement with contracted hospitals, reflects a proactive stance to maintain continuity of care. These contracted hospitals, which include dispensaries, health centers, county hospitals, and national referral hospitals, are directed to maintain services as the new system is phased in.

Enhanced Healthcare Benefits: Focus on Primary and Preventive Care

One of the key distinctions between NHIF and SHA is the emphasis placed on primary and preventive healthcare under the new scheme. According to the Ministry of Health, SHA introduces a broader array of benefits, with a focus on preventive, promotive, curative, rehabilitative, and palliative care. This shift highlights a paradigm change in Kenya’s healthcare system, moving from a reactive approach to a more preventive one, thus aiming to reduce the overall burden of disease in the country.

Primary health services are particularly prioritized under the new SHA system. This includes routine check-ups, vaccinations, maternal health services, and health education, with the goal of catching health issues early and preventing the escalation of treatable diseases into more severe conditions. Emergency healthcare services have also been enhanced, ensuring quick access to critical care in urgent situations.

SHA will also address non-communicable diseases (NCDs) such as diabetes, cancer, and cardiovascular diseases, which have become leading causes of mortality in Kenya. Through enhanced coverage, the government aims to alleviate the financial strain often associated with managing NCDs, ensuring that patients have access to treatment without fear of financial ruin.

Health Cabinet Secretary Dr. Deborah Barasa emphasized this during her address at the Kenya Medical Supplies Authority (KEMSA) National Supply Chain Centre. She pointed out that SHA, in conjunction with the Social Health Insurance Fund (SHIF), will significantly reduce healthcare costs for Kenyans, while still maintaining quality care standards. The government has also dispatched medical supplies to counties across the country to support the implementation of SHA’s new policies.

“Through the distribution of Health Products and Technologies to Counties across the country, we are taking decisive steps to expand healthcare access to every Kenyan,” Dr. Barasa said.

The supply of essential medical products will support services related to maternal and child health, infectious diseases, and non-communicable diseases, ensuring that facilities are well-equipped to meet the needs of the population. This distribution of supplies is essential in the early stages of SHA implementation, preventing stock shortages and maintaining service quality at healthcare facilities.

SHA’s Structure and the Six Levels of Healthcare

SHA will operate within the country’s established healthcare structure, which organizes healthcare facilities into six levels based on the type of care they provide:

1. Level 1: Community Facilities – These are the most basic health services, often provided at the village or community level. They include community health workers who provide primary care services, education, and referrals to higher levels of care.
2. Level 2: Health Dispensaries – These offer basic outpatient care for common illnesses and injuries. They serve as the first point of contact with the healthcare system for most Kenyans.
3. Level 3: Health Centres – These are slightly more advanced than dispensaries and provide services such as maternity care, immunizations, and outpatient curative services.
4. Level 4: County Hospitals – These offer more comprehensive healthcare services, including inpatient care, surgical procedures, and specialized consultations. They serve as referral hospitals for lower-level facilities.
5. Level 5: County Referral Hospitals – These are larger hospitals that offer specialized healthcare services, including surgery, obstetrics, and gynecology, and serve as referral centers for patients from multiple counties.
6. Level 6: National Referral Hospitals – These are the top-tier hospitals in the country and offer the most specialized healthcare services, including advanced surgeries and treatments for complex medical conditions. They also serve as teaching hospitals for medical students and residents.

By maintaining this tiered structure, SHA ensures that healthcare services are appropriately scaled to meet the needs of the population, from basic preventive care at community facilities to advanced medical procedures at national referral hospitals.

SHA: A Critical Step Toward Universal Health Coverage

The introduction of SHA represents a crucial step in Kenya’s journey towards achieving universal health coverage (UHC). As part of President William Ruto’s healthcare agenda, SHA is expected to make healthcare more affordable, especially for the most vulnerable populations. The system is designed to be more efficient, minimizing bureaucratic hurdles and making it easier for Kenyans to access healthcare services.

The Social Health Insurance Fund (SHIF) will play a central role in financing this expanded healthcare system. Under SHA, contributions are collected through SHIF to ensure that all Kenyans are covered. This fund will be used to subsidize the cost of healthcare, particularly for those who are unable to afford services out of pocket. By pooling resources in this manner, SHA aims to distribute healthcare costs more evenly across the population.

Public Engagement and Registration: Key to SHA’s Success

For SHA to achieve its intended goals, public participation is crucial. Health Cabinet Secretary Dr. Barasa has urged Kenyans to register for SHA services as soon as possible. Registration will ensure that individuals can begin accessing benefits under the new system and that there is no gap in coverage during the transition from NHIF to SHA.

Moreover, the government has emphasized the need for a culture shift towards preventive healthcare, with citizens encouraged to seek medical attention early and promote healthy behaviors within their communities. In doing so, SHA will not only address the current burden of disease but also prevent future healthcare crises.

Conclusion

As SHA replaces NHIF, the future of healthcare in Kenya looks promising. The new system promises enhanced benefits, better access to healthcare, and a focus on preventive care that will serve the country’s growing population. With the government’s commitment to providing uninterrupted services during the transition, Kenyans can rest assured that their healthcare needs will continue to be met, even as the new system takes full effect. The SHA rollout represents a vital leap toward universal health coverage, ensuring that all Kenyans, regardless of their background, can access the care they need to lead healthier lives.