Biggest Winners in the Switch from NHIF to SHA & Benefits They Will Get

The Social Health Authority (SHA) which is set to commence operating on October 1 is an improvement of the National Health Insurance Fund (NHIF).

SHA will manage three funds which include the government-funded Primary Healthcare Fund (PHC), the contributory Social Health Insurance Fund (SHIF) and the government-funded Emergency, Chronic, & Critical Illness Fund (ECCIF).

PHC will cater for basic health services while the SHIF will deal with broader health insurance coverage.

On its part, the ECCIF will cover serious and urgent health conditions with emphasis on preventive, promotive, curative care services, rehabilitative and palliative care.

The Ministry of Health unveiled health packages that offer enhanced benefits, reflecting the government’s commitment to achieving Universal Health Coverage (UHC) for all Kenyans.

These packages aim to provide access to quality, equitable, and affordable healthcare services without causing financial strain.

SHA Outpatient and Inpatient Services

SHA has introduced enhanced outpatient services inclusive of lab diagnostics for diabetes, hypertension, sickle cell anaemia, and asthma in level 4 to level 6 hospitals.

Under in-patient, reimbursement rate is standardized across hospitals irrespective of whether it is a private or public facility.

SHA will cover admission costs, x-rays and ultrasound, medicine, physiotherapy, oxygen, blood products, and follow-up after discharge.

Linda Mama

Under the SHA benefits package, the Linda mama programme has been expanded.

Antenatal care visits now include essential services like Anti-D serum for Rh-negative mothers and one ultrasound, as recommended by the Ministry of Health.

Postnatal care has also been extended to six visits from the previous two.

The enhanced package covers all complications related to pregnancy, delivery and newborn care, either under inpatient services or critical care.

It will cover Level 2 to Level 6 hospitals for normal, assisted and caesarian deliveries: aftercare for mother and newborn; operation, treatment and maternity ward costs, lab tests, blood products and oxygen; managing infections, birth traumas, childbirth related conditions and family planning.

Also Read: Govt Issues Directives to Hospitals Countrywide Ahead of SHIF Rollout

Renal Services

At the same time, Renal services have been enhanced under SHA. It covers enhanced management in Level 3 to Level 6 hospitals for dialysis, routine lab tests, catheter insertion and removal, medicine, consultation and review.

It will also cater for kidney transplant for donor and recipient and post-transplant immunosuppressants.

Additionally, cancer management is catered for in Level 3 to Level 6 hospitals for radiotherapy, chemotherapy and other treatments, consumables for treatments, lab investigations, blood products, surgical procedures, and more.

Mental Health

Under mental health services, SHA has increased the rate of reimbursement for drug and substance abuse rehabilitation.

The new packages also entail hematology and oncology services that have an expanded scope that includes management of sickle cell disease, diagnosis and staging of cancers as well as standardized treatment of cancers based on clinical guidelines.

Emergency Services

When it comes to the emergency evacuation and treatment, the packages include emergency evacuation from the point of the incident to the nearest facility.

This will be accessible to all Kenyans regardless of registration or premium payment status.

The coverage includes heart attacks, breathing difficulties, major trauma, shock, seizures, snake bites, and dog attacks.

The fund also covers critical care admission in ICU or HDU at level 4 to level 6 hospitals.

Resuscitation and stabilization in life threatening conditions such as ICU and HDU is also guaranteed and is accessible to all Kenyans, regardless of registration or premium payment status.

Assistive Devices

Before a sick member goes for a kidney transplant, the tests and evaluations for the donor and the recipient will be catered for at Ksh150,000. SHA will also cater for the removal of the donor kidney at cost of Ksh168,000. 

Post-renal replacement therapy will be covered at an annual limit of Ksh 200,000 per household.

Diagnosis, staging, and treatment of cancer have a coverage limit of up to Ksh400,000 for various oncological services, which include chemotherapy administration, PET scans, CT scans, MRIs, radiotherapy, and brachytherapy, among others.

Meanwhile, two years after the rollout, those who lose their loved ones will receive coverage of Ksh3,000 for embalming and Ksh500 per day for body storage for up to 5 days before burial.

The registration to SHIF can be done through self-registration by use of USSD code *147# or via the online platform on www.sha.go.ke.