Government and Policy

SHIF: The Policy That Has Told Kenyans, Do Not Get Sick At All, No Matter What, As They Loot

BY Steve Biko · October 2, 2024 03:10 pm

Kenya’s latest healthcare initiative, the Social Health Insurance Fund (SHIF), is being marketed as the key to solving the country’s crippling out-of-pocket healthcare expenditure. Unfortunately, the reality is far from this promise. The entire structure of SHIF, from the benefits to the tariffs, is not just flawed—it is outright dangerous. This scheme is nothing short of a grand fraud that will lead Kenyans into financial ruin rather than offering them any semblance of healthcare security.

The Mirage of Universal Health Coverage

Universal health coverage is meant to protect citizens from financial ruin when they fall sick. At the core of this concept is financial risk protection, which aims to reduce the out-of-pocket expenditure of every citizen. But will SHIF achieve this? Absolutely not. Instead, SHIF’s benefits and tariffs are so limited that they offer nothing close to financial protection. In fact, the message is clear: *if SHIF is your medical cover, do not get sick at all*.

Artificial Limits on Healthcare Access

One of the most outrageous aspects of SHIF is the cap on the number of hospital visits per household each year. Sickness doesn’t follow a calendar. How can a system possibly justify restricting access to healthcare based on arbitrary limits? What happens when you or your family members fall ill more often than the SHIF permits? The system simply shuts the door on you, and you’re forced to dig deep into your already strained finances.

Inadequate Allocations for Treatment

Even if you manage to stay within the ridiculous limits of the SHIF system, the amounts allocated for treatment are laughable. For outpatient services, SHIF allocates a meager Kshs 900 per person per year. Yes, you read that right—Kshs 900. In a country. where basic consultation fees in most hospitals far exceed Kshs 900, this amount is a blatant insult to the healthcare needs of Kenyans. Inpatient services aren’t spared from this mockery either, with an allocation of Kshs 2,240 per day. These amounts are woefully inadequate and unrealistic, leaving Kenyans exposed to the very financial ruin SHIF claims to prevent.

One Sickness, One Family Collapse

Imagine you are a family of four, and one member falls seriously ill, using up the entire allocated amount for outpatient services in one hospital visit. What happens if another member gets sick within the same year? You will be forced to pay out of pocket. This means, under SHIF, one sickness can devastate the entire family’s financial stability, and there is no fallback.

Unplanned Healthcare Costs

When your family’s medical needs exceed the paltry allocation SHIF provides, who will cover the extra costs? The answer is simple: *you will*. You will be forced to co-pay either by purchasing additional private insurance (which costs even more) or directly from your pocket. This is after you’ve already been contributing 2.75% of your income, regardless of whether you are in the formal or informal sector. It’s a lose-lose situation.

Double Taxation in Disguise

SHIF essentially introduces a form of double taxation. You are already contributing to the system through the mandated 2.75% of your income, and then, when the cover inevitably falls short, you will have to dig into your pockets again to pay for treatment. It’s a vicious cycle of payments that burdens Kenyans without providing any meaningful healthcare cover.

Three Funds, One Catastrophe

SHIF is part of a broader structure under the Social Health Authority (SHA), which includes three funds: the Primary Healthcare Fund, the Social Health Insurance Fund (SHIF), and the Emergency and Chronic Illnesses Fund. However, the government’s blatant underfunding of these funds only compounds the problem. They promise comprehensive healthcare, yet they cannot even allocate the necessary resources.

The Crippling Deficit of the Primary Healthcare Fund

The Primary Healthcare Fund was allocated only Kshs 4.1 billion out of a requested Kshs 50 billion by the Ministry of Health, leaving a shocking deficit of Kshs 45.9 billion. This underfunding renders the entire system ineffective from the start. If the foundation of primary healthcare is this severely neglected, how can we expect SHIF to provide any meaningful service?

The Emergency and Chronic Illness Fund: A Death Sentence

Even more disheartening is the allocation for the Emergency, Chronic, and Critical Illness Fund. The government allocated a paltry Kshs 500 million out of the requested Kshs 49.5 billion. This staggering shortfall of Kshs 49 billion means that in the event of chronic illness or emergency, Kenyans are on their own. The SHIF scheme effectively condemns those with chronic diseases to a financial death sentence.

The Grand Total: A National Betrayal

In total, the government has allocated a mere Kshs 6.1 billion for the SHA, which is a pitiful 3.6% of the Kshs 168 billion required for full implementation. If the government were truly committed to providing quality healthcare, they would have funded these crucial programs adequately. This blatant underfunding proves that SHIF is nothing more than a façade.

The Inequality Trap

The structure of SHIF is also deeply inequitable. The contribution system punishes those who earn more by demanding an exorbitant percentage of their income while setting a fixed rate for those who earn less or nothing at all. This system is unjustifiable and perpetuates income inequality. Contributions should not be based on labor or income taxes but rather on a general tax payable by all citizens.

SHIF: A Healthcare Mirage

SHIF does not offer financial protection, equitable access, or adequate funding for healthcare. Instead, it is a mirage designed to trick Kenyans into believing they have coverage while leaving them exposed to financial ruin. It is clear that SHIF is not about healthcare; it is about exploitation.

Private Insurance: The Only Way Out

Under SHIF, the only way to ensure adequate healthcare for your family is to buy additional private insurance, which completely defeats the purpose of the program. Why contribute to a broken system when you must pay extra to get the coverage you need? This creates a system where the wealthy can afford proper care, and the poor are left to suffer.

Contributions vs. Benefits: A Losing Game

The 2.75% mandatory contribution is not reflected in the benefits. Kenyans are paying far more into the system than they will ever get out of it. This disparity is especially pronounced for those in the formal sector who are forced to contribute large sums, only to find that SHIF’s allocations barely cover the most basic of healthcare services.

The Myth of Financial Risk Protection

SHIF’s core promise of financial risk protection is nothing more than a myth. Instead of protecting Kenyans from catastrophic healthcare costs, SHIF will drive them deeper into poverty. As healthcare costs continue to rise, SHIF’s insufficient benefits will leave families with no choice but to incur out-of-pocket expenses.

Healthcare Rationing: The Future Under SHIF

With arbitrary limits on the number of hospital visits and inadequate funding for primary healthcare, SHIF is a recipe for healthcare rationing. Only those who can afford to pay for private care will have access to timely, quality healthcare. The rest will be left in long queues or denied care altogether.

The Incompetence Behind SHIF

The leadership behind SHIF must be questioned. How can those entrusted with the nation’s healthcare create such a disastrous system? The incompetence at the highest levels of government is on full display with SHIF, which is not just poorly designed but actively harmful to the people it is supposed to serve.

The Hidden Agenda: Profiting from Sickness

SHIF is not about healthcare—it’s about profit. By forcing Kenyans to co-pay or buy private insurance on top of their mandatory contributions, SHIF ensures that the health sector continues to profit off the backs of suffering citizens. The system is rigged to enrich a few at the expense of many.

A Policy of Exclusion

SHIF’s inadequate funding and restrictive benefits package create a policy of exclusion, where only those who can pay more have access to quality healthcare. This system is set up to fail the most vulnerable in society, leaving millions of Kenyans without adequate care when they need it most.

SHIF’s Long-Term Consequences

The long-term consequences of SHIF are dire. As families are forced to pay out of pocket for healthcare, poverty will increase, public trust in government will erode, and the already-strained healthcare system will collapse under the weight of unmet needs. SHIF is setting the country on a dangerous path.

The Fallacy of Government Commitment

If the government were truly committed to providing healthcare, why slash the healthcare budget? The underfunding of crucial programs like the Emergency and Chronic Illness Fund and the Primary Healthcare Fund speaks volumes about the government’s priorities—or lack thereof.

Kenyans Deserve Better

Kenyans deserve better than SHIF. They deserve a healthcare system that works, one that provides real financial protection, equitable access, and adequate care. SHIF offers none of this. Instead, it is a poorly conceived, underfunded, and exploitative program that will cause more harm than good.

The Real Solution: Scrap SHIF

The only real solution is to scrap SHIF entirely and instead reform NHIF. The government must engage with healthcare professionals, economists, and the public to reform NHIF and ensure that it truly works. Until then, SHIF remains nothing more than a platform for looting the country dry.

Refuse to Participate in SHIF’s Exploitation

Kenyans must refuse to be part of this fraudulent scheme. Do not allow SHIF to take your hard-earned money while leaving you with inadequate healthcare. Demand accountability from the government and refuse to pay into a broken system.

The Fight for Healthcare Justice Begins Now

The fight for healthcare justice in Kenya is far from over. SHIF may be the latest attempt to exploit Kenyans, but it will not be the last. It is up to us to demand better, to fight for a system that truly protects and serves the people. SHIF is not the answer—it is the problem.