As the clock ticks towards October 1, the government is racing against time to put the finishing touches to the new health reform— the Social Health Insurance Fund (SHIF).
The Ministry of Health on Friday, August 30, unveiled new tariffs under the Social Health Insurance Act (SHIA), outlining the benefits package that promises to reach every Kenyan, yet the reality of what citizens will actually receive under the new scheme is sparking heated debate.
Under the new scheme, cancer, a disease that continues to claim thousands of lives annually in Kenya, has been allocated a maximum cover of Ksh400,000. This support covers the treatment, including chemotherapy, radiotherapy, PET scans, and more.
For those suffering from diabetes, the SHIA offers coverage of up to Ksh4,300 for outpatient services provided in Level 4 to 6 facilities.
In addition, patients with hypertension will receive a cover of Ksh2,850, while those dealing with sickle cell anaemia can expect up to Ksh6,800 annually.
The scheme also addresses the critical issue of inpatient care, setting tariffs for various levels of hospital services. For example, inpatient services in Level 4 hospitals are capped at Ksh3,360, while Level 5 and Level 6 hospitals will charge Ksh3,920 and Ksh4,480, respectively.
Kidney failure, a growing health concern, is also covered under the new tariffs. Patients requiring hemodialysis or hemodiafiltration services will be charged Ksh10,650 per session, while peritoneal dialysis will cost Ksh85,200 per month.
Moreover, the government’s response to the rising maternal mortality rate (MMR) through increased tariffs for deliveries—Ksh10,000 for normal births and Ksh30,000 for C-sections—offers some relief, but it’s unclear if this will cover the actual costs faced by pregnant mothers.
Heakth Cabinet Secretary Dr Deborah Barasa, leading the charge on the SHIF rollout, remains optimistic. She highlights the scheme’s inclusivity, which aims to extend coverage to 100 per cent of the population, a significant leap from the current 28 pre cent.
During the National Validation Forum for the new tariffs, she emphasised that the new SHIF is a critical step towards achieving affordable and quality healthcare for all Kenyans. Yet, the numbers tell a different story.
Inpatient services, for instance, have been structured with tariffs of Ksh3,360 at Level 4 hospitals, Ksh3,920 at Level 5, and Ksh4,480 at Level 6, with a maximum admission period of 180 days per household. This coverage is set to challenge families already struggling with high medical bills, particularly those requiring prolonged hospitalisation.
The controversy surrounding the SHIA is not new. Declared unconstitutional by the High Court in July due to insufficient public participation and other legal shortcomings, the act, alongside the Primary Health Care Act and Digital Health Act, was suspended for 120 days.
Yet, the government is pushing forward, determined to launch the scheme in October, with promises of addressing the concerns raised during the court’s review period.
