Universal Health Coverage: No pain, no gain

Kenya is aiming to beat the US & India in healthcare service delivery with the launch of the Universal Health Coverage plan.

The government plan has three funds to drive its service delivery which are: Social Health Insurance Fund (SHIF), Primary Health Care Fund and the Emergency Chronic and Critical Illness Fund.

Roll Out

The SHIF was rolled out on October 1, 2024 and is funded through mandatory contributions by all Kenyans over 18 years old. More than 12 million Kenyans found themselves under the scheme after it replaced the now defunct, National Hospital Insurance Fund.

The beneficiaries of the plan are entitled to free access to primary healthcare services under the Primary Healthcare Fund at Level 2 dispensaries, Level 3 health centers and select Level 4 health facilities and emergency services in all health facilities.

So far, all public Level 2 to 6 hospitals have been contracted and are offering services to SHA registered beneficiaries.

Unfulfilled Promises

Healthcare providers and patients have had a difficult week adjusting to the new kid on the block after the government said there was no turning back.

Member verification, claims processing and patient discharge have been extremely challenging with nation-wide reports on service outages affecting both NHIF & SHIF.

In several counties, patients reported being asked to pay for health services out-of-pocket which is contrary to the goal of the scheme. The government has committed to address these issues through the Ministry of Health which directed all healthcare providers and facilities to ensure uninterrupted services for Social Health Authority (SHA) members during the transition from NHIF.

A joint committee comprising of health providers will be constituted to undertake verification of all pending bills incurred under NHIF.

Registration to SHIF is a continuous process and is ongoing via the USSD *147# or the web-based portal on www.sha.go.ke or www.afyayangu.go.ke