The Kenya National Commission on Human Rights (KNCHR) has expressed concerns that the Social Health Insurance Fund (SHA) lacks the capacity and readiness to manage the transition from the National Health Insurance Fund (NHIF) to the new system.
“SHA lacks the capacity and readiness to manage the transition effectively,” KNCHR said in its 2023/24 “State of Human Rights in Kenya” report.
According to the report, SHA has neither absorbed NHIF staff nor recruited its own personnel, resulting in uncertainty and inefficiency in the management of the transition.
The new health scheme officially began on October 1, 2024.
However, the KNCHR report highlights several challenges, including the slow development of the digital platform needed to facilitate the transition, leading to confusion among users such as healthcare workers, SHA officials, and the general public.
The report also points to a lack of coordination between the National and County governments regarding the transition, as well as an incomplete empaneling process for service providers.
This has caused confusion among service providers and patients, particularly those who were receiving long-term treatments under the previous NHIF system.
One of the significant challenges noted is the disruption caused by inefficient data transfer between NHIF and SHA, which has affected service delivery.
Patients who made annual payments to NHIF are now unable to access essential services because of unclear processes for transferring prepaid funds to the new SHA system.
Moreover, long-term NHIF contributors are being denied services because the SHA system inaccurately reflects their membership periods, leading to frustration and a loss of trust in the transition.
The KNCHR also raised concerns over the means-testing process used to determine eligibility for coverage. The accuracy of this tool is at risk, potentially categorizing low-income individuals into higher contribution brackets, which would exclude them from receiving essential healthcare services.
Furthermore, the benefits provided under the SHA are seen as disproportionate to the increased contributions, which does not meet the public’s expectations for improved healthcare services.
The report also noted issues with patient referrals, as the designation of level four hospitals as referral centers from lower-level facilities may complicate access to healthcare for some patients.
For example, patients who previously accessed treatment at nearby level 2 or 3 hospitals may face disruptions in their care due to changes in facility designation and location.
“The Commission cautions that the ongoing registration process should not be limited only to self and online registration to the detriment of people in underserved areas. The indigenous, minority and marginalized communities should be prioritized.”
Additionally, the report highlighted that investments and allocations to the health sector are below the continental threshold of 15%, as outlined in the Abuja Declaration of 2001, which calls for greater funding to strengthen healthcare systems across Africa.
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