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The Ministry of Health in Kenya recently (01/10/2024),  launched the Social Health Authority (SHA), incorporating the Social Health Insurance Fund (SHIF), Primary Health Care, and the Emergency & Chronic Disease Fund. This transition comes with the purpose of replacing the long-standing National Health Insurance Fund (NHIF), which has served as the backbone of healthcare funding in Kenya for many years.

However, the transition has been fraught with challenges, leading to disruptions in the provision of essential health services, leaving many to question: Was SHIF rolled out prematurely?

The Current Situation: Since its inception, SHIF has encountered significant issues, particularly with patients being turned away or forced to pay out-of-pocket for critical services, such as renal treatments and hospital admissions. This disruption is largely due to a lack of a clear communication strategy from the Ministry of Health regarding the transition, resulting in widespread confusion and the disenfranchisement of those who depend on government health funding for survival.

The abrupt nature of the rollout and the unclear framework have led many Kenyans to raise concerns about whether the new system was sufficiently planned and tested before implementation. The government’s failure to guarantee a seamless transfer from NHIF to SHIF echoes similar challenges witnessed during the 2014/2015 transition of teachers and police officers to NHIF. That experience should have served as a valuable lesson in preparedness, planning, and stakeholder engagement.

NHIF: Challenges and Strengths;

NHIF, as Kenya’s main public health insurer, was not without its challenges. Concerns included inefficiencies, corruption, and limited coverage, especially for vulnerable populations. However, NHIF had a well-established network, experienced personnel, and deep-rooted systems for service delivery. While the NHIF needed reforms to improve transparency, efficiency, and service delivery, these issues could potentially have been addressed without a full overhaul of the system.

Strengthening NHIF vs. Establishing SHIF The question arises: Would it have been more prudent to strengthen NHIF rather than establish SHIF?

1. Infrastructure and Experience: NHIF already had existing infrastructure and experience in managing healthcare funds. Strengthening the NHIF could have included digital transformation, improved accountability measures, and targeted interventions to reduce systemic corruption. Leveraging NHIF’s foundation while addressing its weaknesses might have been less disruptive than creating a new system from scratch.
2. Avoiding Disruptions: The transition from NHIF to SHIF has been anything but smooth. Patients who relied on NHIF for critical health services are now facing challenges accessing healthcare. Strengthening NHIF would have minimized such disruptions, as it would have involved incremental improvements rather than replacing the entire system.
3. Stakeholder Engagement and Public Trust: NHIF has been around for years, and Kenyans, despite its flaws, had some level of familiarity and trust in the system. Strengthening NHIF could have retained public trust, which is now at risk with SHIF’s problematic rollout.

Here are some critical lessons that the Ministry of Health could have applied to the SHIF rollout:

1. Clear Communication Plan: During the 2014/2015 transition, inadequate communication led to confusion among healthcare providers and beneficiaries alike. In the case of SHIF, a detailed communication strategy should have been established to inform all stakeholders—healthcare providers, beneficiaries, and administrators—about how the new system would operate, including the timelines, requirements, and potential challenges.
2. Pilot Testing: A pilot phase, involving a select group of beneficiaries and healthcare facilities, could have helped identify potential problems and allowed for adjustments before a nationwide rollout. The absence of pilot testing for SHIF echoes the mistake made during the TSC and police transition.
3. Stakeholder Engagement: The Ministry should have ensured the involvement of all key stakeholders, including healthcare providers, Health Unions, patients, and the insurance authority. Engaging these stakeholders early on would have fostered a sense of ownership, ensured alignment on expectations, and minimized resistance to change.
4. Transition Period: A more extended transition period could have helped avoid disruptions in service delivery. For example, allowing NHIF and SHIF to operate concurrently for a specified period would have given patients time to adjust to the new system without losing access to essential services.

Recommendations for a Seamless Transition:

1. Incremental Rollout: Instead of a complete and abrupt transition, SHIF should have been rolled out incrementally, allowing time to address emerging challenges before nationwide implementation.
2. Strengthening Existing Structures: Rather than replacing NHIF, the Ministry should have considered strengthening its existing structures by addressing inefficiencies, enhancing accountability, and integrating technology to improve transparency.
3. Comprehensive Training: Healthcare providers, administrative staff, and other stakeholders should have received comprehensive training to understand the new system, ensuring they were well-prepared to assist beneficiaries effectively.
4. Public Sensitization Campaign: A nationwide public sensitization campaign should have been conducted to educate the public on SHIF, how it differs from NHIF, and what changes they can expect. This would have minimized confusion and ensured Kenyans knew their rights and entitlements under SHIF.
5. Building on NHIF’s Successes: Instead of starting afresh, SHIF could have built on the successes of NHIF, such as its wide network of healthcare providers, while eliminating inefficiencies. Maintaining continuity would have ensured a smooth transition for beneficiaries.

Conclusion: The rollout of SHIF seems to have been done in haste, without adequate preparation or learning from past experiences such as the 2014/2015 TSC and police transitions. Strengthening NHIF might have been a more prudent approach, leveraging existing structures and minimizing the disruptions currently faced by many Kenyans in need of essential health services.

Moving forward, the Ministry of Health must prioritize clear communication, stakeholder engagement, and a phased approach to ensure that health reforms are implemented effectively and without compromising the health of Kenyan citizens. Only through careful planning and inclusive governance can Kenya achieve its goal of universal healthcare for all.

Peace 👌