Government and Policy

The Shift from NHIF to SHIF: A Dangerous Step In The Wrong Direction For Kenya

BY Steve Biko · June 17, 2024 08:06 pm

The shift from the National Health Insurance Fund (NHIF) to the Social Health Insurance Fund (SHIF) in Kenya is a deeply flawed move that the Kenyan people should oppose. Unlike NHIF, which had a tiered contribution system based on income, SHIF mandates a flat rate of 2.75% of gross salary, disproportionately affecting higher earners who will see their contributions skyrocket from a maximum of Sh1,700 under NHIF to as much as Sh27,500 for top earners. This increase in financial burden is just one of many issues.

SHIF also introduces rigid policies such as capped amounts for deliveries, inadequate coverage for antenatal care, and unreasonable restrictions on hospital stays, all of which are likely to lead to higher out-of-pocket expenses and poorer health outcomes.

Furthermore, the lack of comprehensive maternal and child healthcare coverage under SHIF undermines the very essence of Universal Health Coverage (UHC), which aims to provide all individuals with access to necessary health services without financial hardship.

Instead of dismantling NHIF, the government should focus on reforming it to address its inefficiencies and expand its coverage. NHIF has the infrastructure and potential to provide equitable health services if properly managed and reformed. The rushed implementation of SHIF, which bypasses significant stakeholder input, only exacerbates the confusion and fear among Kenyans, potentially compromising the healthcare system’s stability and accessibility.

Therefore, it is imperative for the Kenyan people to resist this transition and advocate for the improvement of NHIF instead. This is because in our healthcare systems, the design of policies should account for the unpredictable nature of diseases. It’s a fact that diseases don’t follow laid down textbook schedules. However, the new Social Health Insurance Fund (SHIF) policy seems to be crafted under the erroneous assumption that they do.

Inadequate Coverage for Maternal Health

The SHIF policy’s fixed amounts allocated for deliveries—Sh11,200 for normal deliveries and Sh32,600 for C-sections—are grossly insufficient. These amounts fail to cover the actual costs, especially in cases involving complications or in higher-cost healthcare facilities. This shortfall will inevitably lead to out-of-pocket expenses for mothers, resulting in catastrophic expenditure. Effective healthcare policies must ensure that all mothers and infants receive the necessary care without undue financial or procedural burdens.

Restrictive Hospital Stays

The policy’s restriction of hospital stays to 48 hours for normal deliveries and 72 hours for C-sections is particularly problematic. Recovery times vary significantly among patients, and complications often necessitate extended stays. Early discharge poses serious risks to the health and life of both mothers and newborns, contradicting the principles of comprehensive and patient-centered care.

Bureaucratic Barriers

SHIF’s requirement for mothers with complications to undergo fresh vetting before accessing extended services introduces bureaucratic delays and barriers to care. This exacerbates the already dire maternal and neonatal outcomes, as timely medical intervention is critical in such scenarios. The policy fails to recognize the urgency and complexity of healthcare needs, instead creating additional hurdles for vulnerable patients.

Lack of Comprehensive Maternal and Child Healthcare

Universal Health Coverage (UHC) aims to provide comprehensive essential primary healthcare. SHIF, however, does not offer a comprehensive framework for maternal and child healthcare, particularly lacking in monitoring and support for potential complications post-delivery. A continuum of care is essential to ensure the well-being of both mother and child, something SHIF does not adequately provide.

Increased Healthcare Costs

Early discharge without proper follow-up care will likely lead to higher readmission rates, thus increasing overall healthcare costs. Preventative care and adequate post-delivery support are more cost-effective in the long run compared to dealing with complications arising from premature discharge. SHIF’s approach is a false economy, saving costs in the short term while incurring greater expenses later.

Insufficient Antenatal Care Coverage

One of the most glaring omissions in SHIF is the lack of coverage for Antenatal Care (ANC) hospital visits. ANC is critical for monitoring the health of both the mother and the fetus, allowing healthcare workers to detect and manage complications early. The World Health Organization (WHO) recommends at least eight ANC visits throughout pregnancy to ensure optimal care and outcomes. By not covering ANC, SHIF undermines efforts to reduce maternal and neonatal mortality.

Age Limits on Cancer Screening

The SHIF policy’s capped age of 50 for prostate cancer screening does not reflect the increased risk among black individuals, where early onset is common. Similarly, the policy’s guidelines for colon cancer screening, starting at age 45, overlook those with genetic predispositions, family history, or symptoms, who require earlier screening. Limiting cervical cancer screening to women aged 30-50 disregards younger and older women who are also at risk. Additionally, the lack of HPV vaccination for boys in Kenya further hampers efforts to reduce cervical and other HPV-related cancers.

Inadequate Eyeglass Consultation and Dispensing

The SHIF’s provision of Sh935 for consultation and dispensing of eyeglasses, capped at Sh1,000 per household and limited to beneficiaries below 18 years, is impractical. This policy sets an inadequate limit for services that typically cost more, and neglects adults who also need vision correction. Untreated vision issues can significantly affect quality of life and productivity, a fact SHIF fails to address.

Insufficient Mortuary Services

Proper funding and resources are essential for mortuaries to function effectively. If SHIF sets a low cap on mortuary services, it must ensure that facilities like Chiromo, Kenyatta, and City are well-equipped to handle demand and provide dignified services. Without adequate facilities and funding, the quality of end-of-life care will be severely compromised.

Cap on Inpatient Services

Capping inpatient services at Sh3,500 to Sh5,000 at Level 4, 5, and 6 hospitals respectively, limited to 50 days per household annually, is discriminatory. This cap does not account for individual needs, disproportionately affecting households with multiple members requiring extended care or those with chronic conditions needing prolonged hospitalization. This limit restricts access to necessary medical care, leading to potential health disparities and unmet medical needs.

Reform NHIF, Don’t Replace It

SHIF, with its numerous limitations and unrealistic provisions, is a step in the wrong direction for Kenya’s healthcare system. Rather than adopting SHIF, the government should focus on reforming and strengthening NHIF to address existing gaps and improve healthcare access and quality. Effective reform of NHIF could ensure comprehensive, patient-centered care that adapts to the unpredictable nature of diseases, safeguarding the health and well-being of all Kenyans.