What to expect from SHA as registration begins today

We have all been added to WhatsApp Groups at one point or another to contribute to family and friends’ medical bills, as the financial ravage of sickness hits families’ pockets regardless of individuals’ social and economic  statuses.

To ease the burden of care, the Kenya Kwanza administration made radical changes that saw the fold-up of the National Health Insurance Fund (NHIF) and establishment of the Social Health Authority.

Hence, effective from today, Kenyans are expected to register for the new medical scheme.

Registration will continue with deductions of 2.75 per cent expected to commence on November 22, 2024, when the repealed National Health Insurance Fund (NHIF) will be officially ceased.

Until then, employees and self-employed people will continue to contribute to NHIF.

Health Cabinet Secretary (CS), Susan Nakhumicha, has maintained that the new scheme is a key pillar in the governments move to actualise Universal Health Coverage (UHC).

“In preparation for the roll-out of the Social Health Insurance and its benefits, I hereby announce that registration shall commence from July 1, 2024,” the CS announced on Friday.

Reification of the new scheme is, however, behind schedule as set under the Social Health Insurance (General) Regulations, 2024.

According to the regulations, Kenyans were to register to the scheme by June 30, 2024, with deductions beginning by July 1, 2024.

The decision to jump-kick the registration process was arrived at in a meeting chaired by President William Ruto at State House on Thursday last week.

An insider told The Standard that the meeting was to brief the president on the progress of the adoption of SHA.

“The briefing at State House was about SHA, and it was agreed to extend the contract for NHIF to allow for registration,” said the insider.

“Based on its progress, the head of state gave the go-ahead for registration. This will give the system time, even with (s) hitch in registration, to ensure there is seamless transmission,” he added.

Delay in registration, according to the source, is attributed to feedback on tariffs from stakeholders that is being considered for incorporation before gazettement.

The withdrawal of the Finance Bill 2024, amid the unprecedented national-wide protests that saw parliament breached, also affected the process.

The bill sought to finance the Primary Healthcare and Emergency, Chronic and Critical Illness Funds, with the money that was to come from the exchequer.

Additionally, the withdrawn bill had set aside funds for indigents and vulnerable persons.

“Experts have gone back to the drawing board, to have money re-allocated and find priority areas, a turn that might affect the amount of benefit” said the source.

The new scheme also brings on board three funds, namely, the  Social Health Insurance Fund (SHIF), Primary Healthcare Fund, and the Emergency, Critical and Chronic Fund.

Primary Healthcare Fund is fully government financed, to provide care at Level 2 and 3 Hospitals.

Deductions of 2.75 per cent will go to SHIF, that will offer services at Level 4, 5 and 6 hospitals.

Individuals who deplete their SHIF cover will access care using Emergency, Chronic and Critical Illness Fund, at Level 6 hospitals.

Nakhumicha added, “The Ministry is reworking to align to this reality. Therefore, the existing NHIF contributions and benefits will continue until we roll over to SHA,”

“Public participation on traffics has been done, and report received. In course of next week, we shall be doing a national validation exercise after which we shall be able to access services,” said Nakhumicha.

In an interview with The Standard, Medical Services Principal Secretary (PS), Harry Kimtai, emphasised the CS’s sentiments that national validation will kick off soon.

“We shall announce when validation will be done. SHA board has looked at comments from stakeholders, and is incorporating the comments and will undertake the national validation that is expected soon,” said  Kimtai.

He added that registration is a continuous process conducted through self-registration by use of USSD code *147# or via the online platform on www.sha.go.ke. All NHIF branch offices across the country will also be used as registration centres, in addition to support by Community Health Promoters at villages.

“Come November 22, we shall not have NHIF. All activities are being done under NHIF, but by November 22, 2024, there will be no entity called NHIF completely,” said Kimtai.

Right now, they are winding up. They are closing the board and signing off some of the assets and liabilities, verifying and approving, and handing over to SHA,” the PS declared.

Hospital contracts that were to be terminated by June 30 have also been extended by three months .

 “In order to fully comply with the provisions of the SHI Act, the CS has directed that payment and access to the new benefits package under the authority is now scheduled to begin from October 1, 2024,” reads a section of a letter to health facilities by Acting SHA CEO, Elijah Wachira.

It adds, “This is to inform you therefore, that SHA (which has taken over from the NHIF), has resolved to extend the current healthcare provider contracts for a period of three months effective July 1, 2024 to September 30, 2024 to allow for seamless transition from NHIF to SHA”.

Deductions to SHA has been capped at 2.75 per cent, with high income earners expected to pay more to the scheme as compared to low earners.

The lowest contributor is expected pay Kshs 300, against the current Kshs 500 paid to NHIF.

In the new law, all Kenyans will be expected to pay to the scheme, except for indigents whose contribution will be made by government.

Also in the regulations, a contributor will pay separately for each individual spouse, under the Social Health Insurance Fund (SHIF).

For example, if a husband and wife are is earning the same amount of say Sh100,000, each will pay 2.75 per cent. And if they agree on joint contribution, a total of 5.50 percent will be deducted from one of the two salaries.

A household in the Act is defined as a social unit comprising of an eligible contributor, whether contributing by self or paid for, and their beneficiaries; or who share the same socio-economic needs associated with consumption and production.

SHA deductions for employed beneficiaries will be done monthly, whereas those in informal sector will pay annually to the scheme.

Services have also been standardised devoid of the amount contributed to the scheme. For example, those paying Sh300 and those paying more than Sh1 million will be able to access equal services under SHA.

“SHA will not have a mix of schemes that are going to be run, it is one package for everyone regardless of contribution. This is the principal to SHA,” said Dr. Timothy Olweny, who chairs the Social Health Authority.

Unlike previously where NHIF favoured private hospitals, the new scheme has standardised tariffs to all facilties – private and public.

For example, SHA is expected to remit Kshs 11,200 for normal deliveries and Kshs 32, 600 for Caesarian Section (C-Section).

Dialysis has been allocated Sh10,650 per session, and peritoneal dialysis allocated Kshs 180,00 per month.

In the scheme, mental health services include rehabilitation for substance-related addictive disorders, screening, management and referral of behavioural disorders, affective and psychoactive disorders and mental health education.

In-patient service for mental illnesses will be allocated Kshs 1,200 per visit, in addition to Kshs 12,500 for rehabilitation.

With increased cases of cancer, the cover will remit Kshs 5,000 for administering chemo, Kshs 53,500 for PET Scan, Kshs 40,000 for brachytherapy and up to Kshs 3,600 per session for radiotherapy.

Currently, NIHF pays for 16 chemotherapy  sessions and 21 radiotherapy sessions to any patient with a cover.

Mortuary fee of Kshs 500 per day has also been included in the new scheme, a service that was not under NHIF.

For smooth service delivery, Kimtai said public, private and Faith Based Organisation facilities will need to review the proposed tariffs and improve on their infrastructure, human resource among others, for them to offer services as indicated in the tariffs.

“Public engagement and facility preparedness will bring a balance to determinants to the success of SHA,” said the official.

Under the new scheme, health benefits will be accessed in all facilities accredited by SHA, and licensed by medical council.