The committee set up by the Ministry of Health to monitor the smooth transition to the new Social Health Insurance Fund (SHIF) has recommended that the plan be suspended from July 1, citing challenges with the digital platform designed to support contributions and registration.
The transition committee at the Social Health Authority (SHA) – the agency created to run the SHIF and replace the National Health Insurance Fund (NHIF) – said in its report that the pilot opening of the ICT system showed that it was not ready for the shift, with less than a week to go.
The Health Ministry, the team said, should consider continuing the NHIF and keep in mind the regulations it has issued on the new scheme.
“The ICT SHA system has been piloted in Marsabit dry run saying that the new system is not ready and the challenges are being addressed and the second dry run that includes proxy means that the testing can be completed afterwards,” said the committee in a report after the last meeting. Friday.
“ITC experts are asked to report SHA alternatives on ICT systems especially in the domain of registration and contributions. There is a need for alternative solutions even if it includes keeping in mind the SHA regulations and using the NHIF system and the latter has financial implications. The nature of the contract with the license and contract of the NHIF system now needs to be updated .
The committee led by Dr. Jason Kap-Kirwok was inaugurated on January 30, 2024, by Health Cabinet Secretary Susan Nakhumicha.
Ms Nakhumicha at the end of March issued a regulation indicating that the SHIF will start on July 1.
All Kenyans above the age of 18 must make a mandatory contribution to the SHIF, with billions of shillings earmarked to fund universal health coverage (UHC).
In a plan announced by the Ministry of Health, Kenyan workers will pay 2.75 percent of their monthly gross to the SHIF from July 1 – a move that will see the contribution of the highest earners more than eight times in the economy taking home. of many workers has shrunk due to spiraling inflation.
For example, salaried workers earning up to Sh50,000 a month will face a deduction of Sh1,375 under SHIF, up from Sh1,200 contributed under NHIF. For workers earning Sh100,000 a month, the deduction will be Sh2,750, up from Sh1,700 currently paid under the NHIF—which represents a 62 per cent jump. Those paying a gross of Sh500,000 will see their deduction increase eightfold to Sh13,750 unless the cap is introduced.
For those on the lowest incomes, there is some relief under SHIF. For example, for a worker with a gross salary of Sh20,000, the deduction to SHIF will be Sh550 compared to Sh750 under NHIF.
Kenyans, who have no source of income, must also pay at least Sh300 per month to SHIF as the State targets a large funding pool to finance UHC.
The recommendations of the SHA transition committee, however, undermined the plan which will impact the country, especially due to challenges with the NHIF which has even seen some private hospitals cut ties with the scheme due to unsustainable demands.
More than 400 members of the Kenya Rural Private Hospitals Association (Rupha) in May stopped receiving their NHIF cards amid claims that the insurer owed them more than Sh6 billion – a staggering amount that has hampered operations.
Earlier this year, the Ministry of Health said that the ICT system, which will be a centralized management system for health providers, will cost at least Sh5 billion to set up, an amount that could drop if the proposal to overhaul the NHIF System goes through, leaving Kenyans who are supposed to contribute of monthly income to plan in a dilemma.
Last month, some Members of Parliament expressed concern about the lack of transparency on the system used by the SHA to enroll Kenyans into the new health scheme and asked the ministry to delay the enrollment of Kenyans into the SHIF, which had already started, until it clarified how to get the ICT system used to enroll them member.
Lawmakers on the Health Committee claimed that the system was sold without due process and put Kenyans’ lives at risk by failing to ensure the security of personal data collected.
“The system used by the SHA to register Kenyans on the new health scheme is shrouded in ambiguity; we do not know the names of the IT companies used, the costs, or the extent of the data that has been collected. On the face of it, this appears to be a breeding ground for corruption, ” said Anthony Kibagendi, MP for Kitutu Chache South.
Section 47 of the SHIF requires digitization and processes to be carried out using appropriate, reliable, secure, operable, verifiable and responsive technologies through information systems.
Processes and services include member registration, member identification, contribution to funds, facility empanelment, contract execution, member identification, notification and pre-authorization, claims management, and claims settlement.
It further states that every Kenyan must be uniquely identified for the delivery of health services, and the digitization of processes and services must comply with the provisions of the Data Protection Act 2019 and all other relevant laws.
The latest development comes at a time when the ministry has not yet started meaning tests are being carried out to identify vulnerable households in need of financial assistance. Under the NHIF, the ceiling is Sh1,700, a figure that will be multiplied for certain cadres with high incomes. While non-salaries used to pay Sh500 per month to NHIF, this will be reduced to Sh300 under the new scheme.