KENYA—Following the approval of Universal Health Coverage reform, the National Health Insurance Fund (NHIF) will be replaced by the Social Health Insurance Fund (SHIF), with SHIF only mandated to provide social health insurance.
Prior to the reenactment of the Social Health Insurance Act, the NHIF could engage in commercial insurance, which allowed them to procure insurance from other providers while charging a 5% fee on each contract issued to insurers.
As a result, the NHIF focused on making money from insurers, abandoning its primary mission of providing social insurance services.
SHIF will now relinquish the mandate held by its predecessor, allowing Patrick Wanjuki, director general of the Public Procurement Regulatory Authority (PPRA), to draft guidelines for public procurement of commercial insurance.
Four legislations have been passed into law as part of the Universal Health Coverage reform: the Primary Health Care Bill, 2023; the Digital Health Bill, 2023; the Facility Improvement Financing Bill, 2023; and the new Social Health Insurance Bill, 2023.
The new Social Health Insurance law has replaced the present National Health Insurance Fund with three new funds: the Primary Healthcare Fund, the Social Health Insurance Fund, and the Emergency, Chronic, and Critical Illness Fund.
The government, according to President Ruto, is eager to ring-fence healthcare funds through facility improvement legislation at the national and county government levels under the Facility Improvement Financing Act, 2023, in which each institution will keep a portion of the cash they collect from operations.
The new legislation now obliges the National Assembly to designate funds to the SHIF each fiscal year to carry out its social health insurance functions.
“Money appropriated by the national assembly for indigent and vulnerable persons and gifts, grants, innovative financing mechanisms, or donations shall be paid into the fund,” according to the law.
Additionally, SHIF would no longer be able to access enhanced public schemes and other improved benefits such as group Personal Accident (GPA), work injury benefits (Wiba), and Group Life (GL).
With the health insurance reforms, SHIF will no longer have room for expanding schemes and commercial insurance, which resulted in an increase in malpractices such as fraud, overbilling, overtreatment, or collaboration of contracting hospitals and NHIF staff, as was the case with the NHIF.
In addition to authorized funding, President Ruto’s reforms have established a new plan that requires salaried persons to contribute 2.75 percent of their salaries to cushion the poor, with the goal of reaching UHC through a fully funded primary healthcare mechanism.
These funds will assure publicly funded primary healthcare, emergency care, and universal health insurance, as well as equitable access to quality health services. It will also include preventive, promotional, curative, palliative, and rehabilitative treatments.
As it stands, the public is doubtful of the President’s ability to preserve the UHC’s vast budget from corrupt officials, considering that social assistance funds have previously been embezzled with impunity.
The public is also curious about how it will be used prudently in order to avoid the financial problems that have plagued previous attempts to establish the UHC, even in pilot counties.
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