2024 witnessed a shift from the now-defunct National Health Insurance Fund (NHIF) to the controversial Social Health Insurance Fund (SHIF) that is administered by the Social Health Authority (SHA).
SHA has been mandated to manage the SHIF, which replaced NHIF.
The transition from NHIF to SHIF was effected on October 1, 2024, with the new fund expected to raise Ksh148 billion annually through member contributions.
The member contributions will be determined by means-testing instruments for those without formal employment.
Three consortiums, led by Safaricom, have been mandated to develop a new healthcare information management system, an integrated healthcare information technology system (IHTS) at a cost of Ksh104 billion recoverable over a period of ten years.
However, despite all the effort the government has directed towards SHIF/SHA, Kenyans are still suffering as they cannot access healthcare using the new medical cover as a result of the many technical challenges experienced during the rollout.
As Kenyans struggle to embrace the SHIF/SHA, here are some five straightforward benefits they will always remember about NHIF.
1. Enhanced Scheme (ES)
The Enhanced Scheme (ES) was a negotiated comprehensive cover between a procuring entity and NHIF.
It used to be an enhancement from the National Health Scheme (NHS), and covered Civil Servants, National Police and Prison Service (NPS/KPS), County Governments, Parastatals, Pension Schemes for Retired Public officers e.g. The Kenya Association of Retired Officers (KARO), Water & Sewerage Companies, Public Universities among others.
2. Linda Mama Program
Linda mama started as Free Maternity Services which was introduced by the government in June 2013.
The scheme was administered by the Ministry of Health (MoH).
In July 2016, the Free Maternity Services Program was transitioned to NHIF, and was rebranded to become Linda Mama which was launched in Nairobi in October 2016.
Linda Mama was a Government Flagship program administered through NHIF.
It was rolled out in NHIF on April 1, 2017. It was a nationwide programme funded by the GOK, World Bank and JICA and targeted all pregnant women who are Kenyan citizens.
The cover period used to be one (1) year which commenced from the time the cover is activated at the healthcare facility.
Linda Mama provided a package of basic health services accessed by all in the targeted population on the basis of need and not ability to pay, positioning Kenya on the pathway to Universal Health Coverage ( UHC).
It ensured that pregnant women and infants have access to quality and affordable health services.
3. Maternal and Child Health Services
Beyond Linda Mama, NHIF also covered family planning, immunizations, and pediatric treatments for young children.
4. NHIF UHC Supa Cover
Universal Health Coverage (UHC) rolled out by the Ministry of Health and NHIF presented an opportunity to ensure that the people of Kenya have access to the health services they need without suffering financial hardship.
The NHIF Supa Cover was a comprehensive health package that covered individuals and families for both outpatient and inpatient services.
Members could access the following packages under the NHIF UHC Supa Cover:
- Inpatient Benefit Package: The benefit package included a hospital stay with health care diagnosis, procedure and treatment including Consultations and specialist doctor’s fees, bed charges, Nursing care, diagnostic laboratory & radiology investigations, prescribed medications and dressings.
- Outpatient Benefit Package: The package included consultation with a GP, laboratory and radiological investigations including X-rays and ultrasounds, day-care procedures, drugs and dispensation, health education, mental and behavioural health services, counselling, physiotherapy services, Antenatal and Post Natal care, immunization/vaccines as per KEPI schedule, anti-snake venom and anti-rabies.
- Maternity Benefit Package: It catered for pregnancy-related health services which included facilitation of labour, delivery through Normal delivery or caesarean section and aftercare for the mother together with the newborn.
- Renal Dialysis Benefit Package: Covered Haemodialysis including specialist review, nursing & dialysis services, intra-care & dispensed medications, routine laboratory tests, nutrition, counselling & follow-up care.
- Oncology Benefit Package: Included treatment for cancer patients using radiotherapy, brachytherapy, chemotherapy, immunotherapy, PET scans and other interventions as guided by the Ministry of Health (MoH).
- Surgical Benefit Package: All surgical procedures including transplants were covered. Cosmetic surgeries were, however, excluded. Cosmetic surgery is where a person chooses to have an operation, or invasive medical procedure, to change their physical appearance for cosmetic rather than medical reasons. The surgical procedure benefit package included preoperative reviews, operations costs, surgeon’s and anaesthetist fees, nursing care, bed charges, and prescribed medication during hospital stay and discharge.
- Radiology Benefit Package: Included diagnostic imaging services for MRIs and CT scans.
- Mental and Behavioural Health Benefit Package: The Mental & Behavioural Health Benefit Package covered common mental disorders (including depression and anxiety), severe mental disorders (including psychosis, schizophrenia and bipolar disorder); Neurological disorders (such as epilepsy and dementia), childhood disorders, and drugs and substance abuse disorders.
- Emergency Care Benefit Package: This covered road ambulance services via the Kenya Red Cross E-Plus ambulances. It catered for on-site evacuation and transfer of a sick member or their declared dependents for treatment to the nearest NHIF-declared hospital.
- Overseas Treatment: This benefit package covered treatment costs pertaining to medical and surgical interventions and PET Scan Imaging, arising from a condition that warrants treatment that’s not available in Kenya.
5. Coverage for the Elderly and Vulnerable
NHIF, under the government’s UHC agenda, subsidized healthcare for vulnerable populations, including the elderly, orphans, and persons with disabilities.
