Ahead of the Government roll out of the Social Health Insurance Fund, Deputy Spokesman Gabriel Mutuma offers insights of the benefit of the scheme that has been designed to replace NHIF as the medical insurance scheme Munira Mandano spoke to Mutuma.

Q. What is the difference? Between NHIF and SHIF?

Social Health Insurance Fund is one of the three funds under Social Health Insurance Act. It’s a contributory scheme similar to NHIF but with much better benefits.

There are two other funds: The Primary Healthcare Fund and The Emergency Critical Care Fund.

The Primary Healthcare Fund will purchase health care services from level two and three facilities as provided in the Primary Healthcare Acts.

The Social Health Insurance Fund will purchase health services from Level 4, 5 and 6 facilities as provided in the Social Health Insurance Act. Emergency Chronic and Critical Care Fund caters for emergencies and chronic diseases.

All the three funds will be Administered by the Social Health Authority.

Q. Who qualifies to be covered by SHIF?

All residents of Kenya are qualified to be covered by SHIF as long as they are registered and have contributed as required by the Social Health Insurance Act and regulations. Oes not need to have made contributions

As stated above SHIF is only one of the Funds under the Act and is a contributory Scheme.

To benefit from the other two funds as a Kenyan one needs to be registered under the Act.

All Kenyan residents will benefit from emergency care whether registered or not.

Q. How much is Social Health Insurance in Kenya?

Each household will pay a contribution of 2.75 percent of their income as social health insurance. The minimum payable is 300 shillings. 

The decision to pay 2.75 percent was arrived after actuaries from both the ministry of health and NHIF did and analysis and found disparities in the amount paid Kenyans.

Kenyans earning lower income were paying more to the fund while those with higher income were contributing a paltry 0.01 per cent.

Q. Will the lowly paid and jobless Kenyans benefit from SHIF?

The low income earners in Kenya are the biggest beneficiary under Social Health Insurance. They will only be required to pay a 300 Shillings to access benefits of the Social Health Insurance. They will be eligible to the same benefits as the higher income earners.

Where a household is unable to pay the premium, the government will upon confirmation by means testing pay the premium on behalf of such household.

Q. NHIF was riddled with corruption and inefficiencies. What measures are in place to ensure SHIF will not have the same fate?

Social Health Insurance Act has separated the functions originally carried out by NHIF to different players. SHA will only purchase health services on behalf of Kenyans.

This will ensure accountability and reduction in fraud cases.

 NHIF used to accredit hospitals offering services under the NHIF system but this function no longer lies with the Social Health Insurance Authority it shall be carried out by a different body.

Social Health Insurance Authority will also be able to outsource for claims management, again, this reduces fraud within the authority.

Q. How will SHIF benefit Kenyans from marginalized regions with few or far-flung medical facilities such as Northern frontier counties.

The government has done Geo mapping of all health facilities in Kenya and will be to ensure the services are available to people all over Kenya.

Q. How will SHIF benefit Kenyans from the pastoral communities who move from one place to another with their livestock in search of water and pasture for their livestock.

The facilities have been geo mapped.