What's next for NHIF contributors? Doubts loom as country moves to SHA

Margaret Okore from Kisumu recalls the painful days when she struggled to access healthcare due to financial difficulties.

On many occasions, she endured pain in her house, as she could not afford out-of-pocket treatment.

Luckily, in June this year, a relative enrolled her in the National Health Insurance Fund (NHIF), which she describes as blessing.

“I am happy because I can now get treatment when sick, unlike the days I would rely on my relatives for support, Okore says. “I can now walk to and from hospital without the financial burden. There were times I could not afford painkillers, and I would just pray for healing,” she tells ‘The Standard on Sunday’.

However, with the recent changes in the health insurance scheme, Okore is unsure whether the money she paid upfront to NHIF will be transferred to the new Social Health Authority (SHA). 

The 67-year old received a message from SHA asking her to register and confirmed its authenticity with her doctor. Now enrolled under the new scheme, she remains hopeful.

“I do whatever brings me help in seeking treatment. I do not have any fears, SHA sent me a message and I knew they had been notified by NHIF that I am a member.

I am currently in the hands of SHA. I expect quality services. I am just waiting for services. If I go to hospital, I should get treatment,” says Okore.

She explains that at her age, she risks several illnesses that require health cover. It is expensive to pay for treatment out of pocket, says the granny who manages conditions such as arthritis, ulcers and hypertension with the NHIF cover.

Okore also advocates for the new health scheme within her village where many people still hold fundraisers for health care.

“People in my village think of the health cover as a luxury. They buy food and clothes, but don’t prioritise health until it’s too late,” she says.

She adds, “People wait until they get sick,  then they realise they should have paid Sh500 to the health scheme”.

Like Okore, hundreds of Kenyans are uncertain about what will happen to their contributions as the Ministry of Health gears up for the official rollout of SHA on Tuesday.

Muthoni Njoroge, who paid for her father’s contribution in advance fears that the money might be lost in the transition. 

She had prepaid for several months to cover her father’s upcoming eye surgery, costing Sh80,000.

“I was told to pay in advance which I did not mind but with the changes in the scheme, I am afraid it will be lost in the confusion. There is no communication on what happens next,” says Njoroge. “It (the money paid upfront) should be transferred and not lost”.

Kenneth Jura, who has been diligently paying NHIF for his elderly parents, echoes similar concerns. “Is the money going to be transferred to the new scheme?" Poses Jura adding “Does this mean they will change the dynamic or how they will receive services?”

Jura had remitted money to the scheme for both of his parents, till December 2025.

“I pay NHIF for my parents because they fall sick most of the time because of their age. I get some sort of relief when they are covered,” Jura tells ‘The Standard on Sunday’.

Jura’s father is ailing from cancer, and with transition, he is hopeful that he will continue receiving the required care.

He enrolled to the scheme in 2018, and pays monthly, quarterly or yearly.

Recently, he reveals that NHIF paid Sh50,000 for his father’s tests that were done at a Nairobi-based hospital, out of the required Sh80,000. He says NHIF came in handy as he was struggling financially.

“For those who do not pay for their parents, and their own health cover, how much are they spending? And how is it also for them, this is why we have very high mortality rates, because it is far-fetched. Sh500 looks so little, but is a lot whenever someone falls sick,” he observes.

Mkamburi Mwawasi who has benefited from NHIF, remains confident in the transition to SHA.

Mwawasi introduced her brother to the scheme to ease financial health burden.

“I paid upfront to NHIF because it really helps. Aside from my other insurance cover, it helps me a lot,” he admits, adding, ”I also introduced my brother just the other day because I do not want him to keep asking me for money so that he seeks medication since I am now their guardian,” says Mwawasi.

Mwawasi is confident that she will continue seeking care under the new scheme.

“I am not so worried by SHA. I will simply visit them and hear what they have to say about the shift if need be,” says the resident from the Coastal region, also a communication professional.

According to her, health insurance cushions someone from emergencies during hard economic times.

“I might get sick at a time I do not have money. But with the cover, I am guaranteed of service.”

Medical Services Principal Secretary Harry Kimtai has moved to allay public fears, assuring Kenyans that NHIF contributions are safe and will be transferred to SHA.

“No one needs to worry about losing even a single shilling with these changes,” Kimtai tells The Standard on Sunday.

“Every contribution will be accounted for and carried forward to SHA.”

 “We shall check the balance (at NHIF) then transfer to new contributions under SHA,” adds the PS.

Kimtai maintains that “registration to the new scheme is a must for all Kenyans”.

SHA, unlike NHIF, he says, will serve all Kenyans.

According to him, NHIF was discriminatory and mostly targeted the employed, limiting non-salaried people who make up at least 80 per cent of Kenyans.

The new scheme does also not have premiums and schemes like NHIF.

For example, it will not offer comprehensive cover that was enjoyed by civil servants.

Civil servants were contributing Sh1,700 monthly for comprehensive cover, money that was paid by the employer from tax payers.

The PS maintains that civil servants are at liberty to get a different health provider.

“All of us shall pay equal amount, it makes us equal. Having civil servants scheme is what was bringing disparity. There was no uniformity,” maintains the senior official.

Presidential health advisor, Dr Daniel Mwai, emphasises that NHIF also did not provide adequate insurance to patients with chronic diseases in need of services like chemotherapy and dialysis.

“As a way of responding to the current health needs, the ministry came up with Social Health Insurance Act that brings on board three funds, namely, Primary Healthcare Fund, Social Health Insurance Fund (SHIF), and the Emergency, Chronic and Critical Illness Fund (ECCIF),” says Mwai.

Efficiency lacks with NHIF according to Dr Mwai, an issue which will be addressed by SHA.

“As per now, the poor are oppressed by law, because the premiums as set are oppressing poor people as they earn less incomes. Within the employed team, the reforms are bringing equity, but not increasing money that is being collected,” says Dr Mwai.

The funding model under SHA, according to Kimtai, is a national social health insurance where the healthy people support the sick, and the young support the old.

“NHIF system is weaker. Everyone should receive quality healthcare, not only those who can afford,” cites Kimtai.

Kimtai pleads with Kenyans to register to the new scheme to cut the financial burden.

Registration to the new scheme is biometric, where Kenyans shall present their Identification Card (ID), alongside verification of fingerprints, unlike the manual registration witnessed at NHIF.

As SHA prepares for its rollout, Jura believes more public education is needed to boost enrolment. He attributes the slow uptake of health cover in Kenya to a lack of awareness.

“People don’t see the need until they’re already sick. We need more information on the benefits of health cover,” he urges, calling for targeted community outreach efforts to raise awareness of SHA’s advantages.