MOH updates SHA tariffs to boost Kenya’s Universal Health Care drive

KENYA—The Ministry of Health has announced updates to the Social Health Authority (SHA) tariffs, a key step towards advancing Universal Health Coverage (UHC) under the Taifa Care program.

This initiative, a cornerstone of the Bottom-Up Economic Transformation Agenda (BETA), aims to ensure that every Kenyan can access affordable, equitable, and high-quality healthcare. 

This development follows concerns raised by stakeholders, including hospitals and clinics, about delays and reimbursement rates under the Social Health Insurance Fund (SHIF).

The SHA was established under the Social Health Insurance (SHI) Act, replacing the National Health Insurance Fund (NHIF) Act 1998.

Its mandate includes pooling resources and strategically purchasing health services from providers through three main funds: the Social Health Insurance Fund (SHIF), the Primary Healthcare Fund (PHCF), and the Emergency, Chronic, and Critical Illness Fund (ECCIF). 

The rollout of SHA began on October 1, 2024, with ongoing efforts to register members, contract healthcare providers, and digitize health systems to enhance accessibility.

According to a statement by Harry Kimtai, CBS, Principal Secretary for Medical Services, SHA’s benefits are guided by tariffs published in November 2024.

These tariffs are designed to ensure sustainable healthcare financing, equitable access, and a shared responsibility model. 

However, beneficiaries may need to make co-payments if hospital charges exceed the specified limits.

SHA offers coverage based on a per diem rate for critical care services in intensive care units (ICUs) and high dependency units (HDUs).

The rates vary depending on the facility level: KES 3,360 (US$26.0) per day for Level 4 hospitals, KES 3,920 (US$30.34) per day for Level 5, and KES 4,480 (US$34.67)per day for Level 6.

Each household has an annual limit of 180 days, and members may need to top up amounts that exceed this cover. This applies uniformly to public, private, and faith-based hospitals.  

SHA also covers critical services such as cancer management, renal care, maternity, and outpatient services.

 The Ministry has also set up a committee to review the tariffs and benefits to address any challenges.

The committee, formed under Regulation 41 of the Social Health Insurance Regulations, will gather stakeholder feedback and propose both short- and long-term solutions to ensure SHA’s sustainability and effectiveness. 

In the meantime, the government has urged all Kenyans to enrol in SHA and ensure timely premium payments. Employers are encouraged to onboard their employees without delay.

Additionally, plans are underway to strengthen the healthcare delivery system, including recapitalising the Kenya Medical Supplies Authority (KEMSA) to ensure a consistent supply of essential medical commodities. 

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