A Rushed Transition: Examining the Shift from NHIF to SHA (Social Health Authority)
The Social Health Insurance Fund (SHIF) laws were rushed through the legislative process and at one point, they were declared unconstitutional for lack of public participation by the High Court. The greenlight for implementation was granted by the Court of Appeal and the government proceeded to implement the laws. However, lack of clear transition plan for the NHIF staff to SHA has proved to be a major obstacle. The staff need to be assured and motivated to embrace and implement the new scheme without looking behind their backs. Unfortunately, their contracts were extended for a period of six months awaiting SHA to undertake its staff establishment. As they lender services they are awaited by three fates, redeployment to SHA or other public institutions, or retire voluntarily. Why was the rush to rollout a new scheme before undertaking staff establishment? Indeed, this was a huge gabble no wonder the parent Ministry of Health seems to be the driving force behind the SHA. Listening to some high-level ministry officials discussing SHA indicates their comprehension is better as compared to that of SHA board and staff.
The promises and realities of SHA are a contrast. Citizens were mobilized to register and promised rosy services, far better than the ones offered by NHIF. But alas, those that sought services from health facilities were heartbroken. The digital registration, approval and claim process were often faced with technical hitches that took longer than anticipated hindering access to services. Most of the health facilities including the private sector took longer to be boarded into the scheme due to trust levels as a result of debts owed to them under the defunct NHIF, forcing many patients to pay out of pocket in order to access the services or miss the services all together. In paper the benefit packages under SHIF far outweigh the NHIF’s as they included outpatient care, inpatient care, chronic diseases management, and specialized treatments. However, this came with an increase in contributions at 2.75% of household income.
These patient stories are a call to action. The question of ‘why the rush?’ is now secondary to the question of ‘how do we fix this?’ We must learn from these experiences, engage with communities, and work collaboratively to build a healthcare system that truly serves the needs of all Kenyans. Let’s move forward with a commitment to a complete and effective SHA, not a half-baked idea.
