The government has temporarily revised the Social Health Authority (SHA) payment policy, to provide relief for informal sector workers who may struggle with lump-sum contributions.
Non-salaried individuals will now have the option to pay their SHA premiums monthly instead of the previously mandated annual lump sum.
Under the gazetted SHA regulations, the transition plan from the now-defunct National Health Insurance Fund (NHIF) to SHA stipulates that those not on payroll make a one-time annual payment before accessing treatment in any of the contracted health facilities.
Initially, the requirement for annual premiums for informal workers was a way to minimise payment defaults.
Many in the informal sector have irregular incomes, and government officials raised concerns that monthly payments would lead to inconsistent contributions, potentially weakening the funding base needed to sustain the Social Health Insurance Fund (SHIF), the only fund designed to pool resources for universal healthcare.
This challenge was familiar from the NHIF days, where inconsistent monthly contributions led to significant gaps in the fund’s resources, affecting service delivery and coverage.
During a journalists’ roundtable on Monday, government officials said the stop-gap measure is an incentive for those in the informal sector to register with the SHA and that the pro rata payment option makes it accessible for individuals who are struggling or may struggle to afford a lump sum.
The scheme requires households to contribute 2.75 per cent of their income. For those who are employed, this percentage is based on their earnings, while for those without a fixed monthly income, contributions are calculated using a means-testing tool that considers both earnings and assets.
Former NHIF Chief Executive, Samson Kuhora, who is now heading the members’ benefits design at SHA said: “There is a provision within the regulations that it needs to be a yearly contribution and internally we have a reminder system meant to make sure that those reminders go out, first of all, three months before the expiry and two weeks before expiry to ensure we have a way of enforcing the compliance. We appreciate that there are challenges in raising the bulk amount, that is why a member can select to pay for one month.”
The SHA official added that the authority is developing an insurance premium financing option, which is expected to be operational within three months.
“The initiative aims to reduce the number of people unable to cover the full 12-month contribution upfront.”
The rollout of the new social health scheme started at the beginning of last month and has since onboarded 13 million Kenyans. Salaried individuals have already started remitting their contributions to the Social Health Insurance Fund (SHIF) as of the month of October.
For informal workers, SHA contributions will be tied to active payments rather than automatic deductions. This means that the requirement for them to pay into SHIF will start after one has been registered.
However, the transition has been far from smooth. Despite the enrollment numbers, some Kenyans have reported missing out on critical services, and many healthcare facilities have struggled to adapt to the new system.
Technical issues, including frequent system crashes, have complicated the process, leading to delays and frustrations for both healthcare providers and patients. In some areas, the lack of information has left residents unaware of the Social Health Insurance Fund (SHIF) and its purpose.
In Kaikor, located in Kibish Sub-County of Turkana County, many residents remain completely unaware of the new social health scheme. Individuals that Nation spoke to had “never heard” of the Social Health Insurance Fund (SHIF) and were similarly not registered under the previous NHIF programme.
“When sick, you just go to the dispensary and they give you medication or you buy. Sometimes, one has to sell a goat to afford the treatment,” said Alim Longor, an expecting mother.
Community health promoters are key in educating and encouraging the masses to register but in this part of the country, even these health promoters are yet to receive information about the scheme. Furthermore, local dispensaries, crucial points of access for many residents, are under-resourced and lack the necessary devices to implement SHA-related services.
The Ministry of Health acknowledges these issues, with officials pledging to address these gaps. Health CS Deborah Barasa likened SHA to a baby “that is not expected to be born and sprint.”
” We are supporting the agenda because it is a nationwide agenda but ultimately it will support every Kenyan in every corner to have access to quality services. We take note of the challenges that we have but as you can see, this is a new system, it is still young. We are working to improve and are working towards having a robust system,” said CS Deborah Barasa.
