Kenya is set on the right trajectory for Universal Health Coverage (UHC) by 2030. Key for this path has been policy reforms and framework to define how health for all would be delivered. On the broader policy landscape in Kenya today, we have the commonly referred UHC laws.
These UHC laws include: the Social Health Insurance (SHI) Law (2023) which creates institutions and legislating the procedures for driving social health insurance in Kenya, the Digital Health Act (2023) which creates an enabling environment for development of digital platform for integrating health system needs and database for the citizens for purposes of health care access, the Facility Improvement Financing Law (2023) which specifically is developed for public health facilities to ensure they are well financed to offer health services to Kenyans, and are well positioned to compete with private health care facilities and the Primary Care Networks Law (2023) that creates the necessary legislation for development of collaborative mechanism for related health care providers in the sub-county level, ensuring collaboration for service delivery and referral mechanisms.
Kenya’s ultimate goal is to have in place a functional and effective social health insurance system which provides equitable and affordable access to healthcare services for all members of the society. Governments objective is to increase health insurance coverage. The health insurance ecosystem as currently is before SHA, has existing fragmented pools targeting different populations cohorts hence creating inefficiencies and an increased cost of health services. These makes the most vulnerable and poor in our society not to be able to access quality health care, and for those who can afford, it creates financial and economic hardship. Therefore, by its design SHI proposes 3 consolidated pools to address the inefficiencies. Different from NHIF, SHA will have three key funds: the Primary Health Care (PHC) Fund, the Social Health Insurance Fund (SHIF) and the Emergency Chronic Illness Fund.
For months now, USAID Health Equity and Resource Optimization (USAID HERO) project has been providing technical assistance to the national Ministry of Health team leading implementation of the SHA. A transition committee was set up to oversee Kenya move from the National Health Insurance Fund (NHIF) to SHA.
The Transition Committee, created in February 2024 will work for 6 months and the two boards (NHIF and SHA) in consultation with the Ministry of Health ensure the transition process is completed within the 12 months provided for in the law. This Committee has in place legal and institutional frameworks; guidelines and operational mechanisms in regard to assets and liabilities, human resources and pensions and other staff benefits; and development of a clear roadmap for winding up of NHIF by July 2024. Registration and onboarding citizens is part of this roadmap and in July 2024, SHA kicked off the exercise in Elgeyo Marakwet County.
USAID HERO Develops Frequently Asked Questions (FAQs)
In preparation to mass registration exercise, USAID HERO in collaboration with the Ministry of Health and Council of Governors has been doing sensitization to County Health Management Teams (CHMTs) across 10 counties. These counties are: Uasin Gishu, Elgeyo Marakwet, Baringo, Nyandarua, Nakuru, Kajiado, Meru, Taita Taveta, Kwale and Kilifi. These sensitizations have been important considering the critical role counties play in delivery of health services in our current devolved dispensation.
USAID HERO technical assistance has also been in the development of a comprehensive booklet which has questions and answers to improve understanding on SHA and why it is important for the country. On 12th July 2024, these useful resource was made available during SHA’s inaugural registration drive at sub-national level in Elgeyo Marakwet County- which is one of the 10 supported by the project.
“For me as a healthcare worker, this booklet now gives me all the answers I need. It was never clear for me what this SHA meant and how different it was with NHIF.” Highlights a health care worker in Elgeyo Marakwet County.
These booklets were provided to strategic groups in the community including Community Health Promoters, National Government Administrative Officers (NGAO) through Chiefs, Sub-Chiefs and Assistant County Commissioners, healthcare workers, political leaders through the Member of the County Assembly (MCA), County Executive Committee Members (CEC-M) through the Chief Officer and CEC-M for Health. The Governor of Elgeyo Marakwet also had an opportunity to access the booklet. In his remarks, Govenor Wisley Rotich urged officers of his government to use the booklet and cascade information further to the citizens even interpreting in the local dialect.
To make this booklet more accessible to a larger audience, USAID HERO has published it on the project microsite and made the link publicly available using QR codes on banners. USAID HERO support to the Transition Committee will be making available copies of these booklets across all counties of operation and targeting members of the media with the information too. Improving access to information about SHA is an important first step towards rolling out this programme which will contribute positively to better health outcomes in Kenya.