On Tuesday, Kenya’s healthcare landscape witnessed a significant shift with the rollout of the Social Health Insurance Fund (SHIF). The newly introduced SHIF replaced the National Health Insurance Fund (NHIF), marking a bold step by the Kenyan government towards restructuring public healthcare financing. However, the transition has been met with criticism from various stakeholders, with the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) leading the opposition.
The KMPDU Secretary-General, Dr. Davji Atellah, was particularly vocal in his condemnation of the new scheme, describing it as a “capsizing ship” that will limit Kenyans’ access to essential healthcare services. Dr. Atellah’s harsh critique has sparked widespread debate about the future of healthcare in Kenya, with concerns focusing on the financial strain the SHIF will place on taxpayers and the overall impact on public health services.
A Healthcare Scheme Under Fire
In a statement issued to the media, Dr. Atellah outlined the concerns of the KMPDU and its membership. His primary argument is that the SHIF is a poorly designed healthcare scheme that will deny ordinary Kenyans access to quality medical care. According to Dr. Atellah, the SHIF is riddled with numerous flaws, including increased deductions from taxpayers, inadequate healthcare benefits, and an inherent bias toward private insurance companies.
“SHIF is a capsizing ship! There is too much bilge water for it to sail,” Dr. Atellah exclaimed in his statement. He went on to accuse the government of implementing a scheme that is financially unsustainable and ill-suited to meet the needs of the general population. For Dr. Atellah, the decision to transition from the NHIF to SHIF is not only regressive but also a betrayal of the public’s trust.
From NHIF to SHIF: A Step Backward?
The transition from the NHIF to SHIF has been one of the most contentious aspects of the new healthcare financing framework. The NHIF, which has been in operation for decades, provided what many perceived as a more comprehensive medical cover compared to private sector insurance plans. Dr. Atellah emphasized that the NHIF offered superior benefits to Kenyans, ensuring access to a wide range of healthcare services, including primary care, specialist consultations, and treatment for chronic diseases.
“A social insurance law with a co-payment component is a fraud,” Dr. Atellah stated, referencing the SHIF’s cost-sharing approach. He added, “We have consistently warned that the comprehensive medical package provided by NHIF was superior to all other private sector insurance plans.”
For the KMPDU, the SHIF’s introduction appears to favor private insurers, allowing them to profit from the shortcomings of the public scheme. Dr. Atellah went so far as to accuse the government of intentionally defunding public healthcare, making it dysfunctional in order to push Kenyans towards private insurance providers. This, he argued, was a deliberate move to benefit corporate interests at the expense of the public good.
The Financial Burden on Taxpayers
One of the most controversial elements of the SHIF is its increased contribution rates. Under the new scheme, employed Kenyans will be required to contribute 2.75% of their income to the SHIF, with no cap on contributions. For individuals earning a modest salary of Ksh.20,000 per month, this equates to an annual payment of Ksh.6,600. However, those with higher incomes will face significantly steeper deductions. For instance, someone earning Ksh.500,000 per month will pay Ksh.165,000 annually, while top corporate executives earning up to Ksh.10 million monthly will see deductions of Ksh.275,000 each month, or Ksh.3.3 million per year.
This progressive contribution model has drawn sharp criticism from Dr. Atellah, who argues that it disproportionately affects taxpayers while offering minimal benefits in return. “We relinquished our medical allowance for comprehensive medical cover, which has now been removed, and yet we are expected to pay five times more – this is insane,” he said.
Limited Benefits, Expensive Contributions
The crux of the opposition to SHIF lies in the perceived mismatch between the high contributions and the limited benefits it offers. According to the details of the scheme, every member, regardless of income, will be entitled to a primary healthcare package worth up to Ksh.900 per year. This amount covers basic services such as primary care consultations, laboratory tests, and prescriptions. However, critics argue that this package is insufficient to meet the healthcare needs of most Kenyans, especially those suffering from chronic conditions or requiring specialized care.
For instance, the SHIF’s optical care coverage is capped at Ksh.1,000 per year per family, regardless of how much a person contributes to the fund. Dental care coverage is limited to Ksh.2,000, but this will only be available when there is sufficient budgetary allocation. Moreover, while cancer screening services are included in the scheme, cancer-specific screening will not be immediately available.
For those managing chronic illnesses such as diabetes, the SHIF offers limited support. The scheme covers the cost of an HbA1c test, which measures blood sugar levels, at Ksh.1,000, but only once a year. This, according to Dr. Atellah, is woefully inadequate for patients who require frequent monitoring and treatment.
Civil Servants Hit Hard
The KMPDU’s opposition to the SHIF extends to civil servants, who, according to Dr. Atellah, are being subjected to “a double robbery.” Previously, civil servants were entitled to comprehensive medical allowances, which provided a level of security in terms of healthcare access. However, with the introduction of SHIF, these allowances have been eliminated, forcing civil servants to rely on a scheme that offers far fewer benefits than they had under the NHIF.
Dr. Atellah accused the government of robbing civil servants of their medical allowances while simultaneously imposing higher contributions through the SHIF. For civil servants, this represents a significant setback, both financially and in terms of healthcare access.
Legal Battles Loom
The KMPDU has not taken the introduction of SHIF lightly. According to Dr. Atellah, the union has taken the fight against the new scheme to the courts, including the Court of Appeal. The legal battle centers around the constitutionality of the SHIF and the perceived violation of Kenyans’ right to access affordable healthcare.
“With the current SHIF tariffs, everyone will be forced to dig deeper into their pockets to access care,” said Dr. Atellah. He also noted that many Members of Parliament (MPs) who passed the legislation enabling SHIF seemed unaware of the scheme’s full implications, leading to widespread discontent among the population.
For the KMPDU, the SHIF represents an attempt to undermine public healthcare in Kenya, making it harder for ordinary citizens to access critical services. Dr. Atellah warned that public healthcare was being intentionally defunded to force Kenyans to turn to private insurers, who stand to profit from the scheme’s shortcomings.
The Road Ahead
As the SHIF takes effect, Kenyans find themselves grappling with uncertainty regarding the future of healthcare in the country. While the government has presented the SHIF as a necessary reform to ensure sustainable healthcare financing, the opposition led by the KMPDU underscores the deep concerns about the scheme’s long-term viability and fairness.
Dr. Atellah’s condemnation of the SHIF has resonated with many who fear that the scheme will exacerbate healthcare inequality, placing a heavier financial burden on those who can least afford it. The ongoing legal battles, coupled with public outcry, suggest that the SHIF may face significant challenges in the months ahead.
As Kenya navigates this healthcare transition, the question remains: will the SHIF provide the comprehensive healthcare coverage that Kenyans need, or will it, as Dr. Atellah claims, deny them access to essential services? Only time will tell.
