- SHIF aims to reduce financial barriers for many underprivileged households, protecting them from the risk of escalating health costs.
- I believe the government has not adequately thought through this aspect, and if they have, they’ve certainly failed to communicate the detailed framework to the public effectively.
- To build trust in this new system, the government needs to open up more on the contentious concerns of many Kenyans.
I have been reflecting on Kenya’s new health policy as it unfolds. Like many other concerned stakeholders and fellow Kenyans, I sense a significant gap in the policy’s collaborative co-creation and implementation process.
This isn’t an isolated issue—many other policies rolled out by the government seem to suffer from the same challenge.
However, in this article, I won’t delve into recommendations for how the government can better engage stakeholders and citizens. Instead, I want to offer my reflections on this policy, viewed through the lens of leadership and governance.
First, I believe the new Social Health Insurance Fund (SHIF) is a bold move towards achieving Universal Health Coverage (UHC), as it aims to ensure that all Kenyans, regardless of income, have access to affordable healthcare.
If implemented effectively, SHIF could be a game-changer. The policy’s intention to reduce the heavy reliance on out-of-pocket healthcare spending and address long-standing coverage gaps, particularly for low-income earners and those in the informal sector, is commendable.
However, the success of SHIF will ultimately hinge on how well the government navigates the opportunities and challenges it presents.
Opportunities
On the positive side, SHIF is designed to expand healthcare coverage, benefiting marginalised and underserved communities that NHIF previously failed to fully reach. While previous NHIF enhancements aimed to address these challenges, the influence of cartels and deeply entrenched corruption hindered the anticipated changes.
In the context of sustainable development, especially when viewed through the lens of care, we are reminded of the principle that “to whom much is given, much is required.”
SHIF aims to reduce financial barriers for many underprivileged households, protecting them from the risk of escalating health costs.
The SHIF policy aligns well with our constitutional commitment to healthcare as a fundamental right {Article 43 (1) (a)}, supporting the broader goal of achieving UHC under Vision 2030. If implemented with integrity, SHIF will not only make healthcare more equitable but also ensure that the most vulnerable members of society have access to essential services.
Integrity is crucial here, without it, the very groups this policy intends to uplift could be further disadvantaged by unethical practices.
Therefore, proper execution of SHIF, free from corruption, is vital to ensuring its intended positive impact on the health and well-being of all Kenyans.
Challenges
However, there are several challenges we, as Kenyans, must address directly. One major concern is the mandatory contributions, especially for informal workers. It raises legitimate questions about how realistic it is to expect consistent payments from irregular-income individuals.
I believe the government has not adequately thought through this aspect, and if they have, they’ve certainly failed to communicate the detailed framework to the public effectively.
While the goal is to build a more sustainable healthcare system, there’s a real risk of imposing an additional financial burden on people who are already struggling, especially considering that over 60% of Kenya’s productive population works in the informal sector. This is a key source of opposition to the policy.
Moreover, I share concerns about the administrative capacity required to run SHIF effectively. If the government struggled to streamline efficiency in collecting NHIF contributions from the informal sector, how ready are they to manage SHIF’s contributions and reimburse healthcare providers in a timely manner? Without solid administrative systems, we risk frustration from both contributors and healthcare providers.
This is where the government’s lack of collaborative leadership becomes evident. The political and legal pushback we’ve already seen, particularly from businesses concerned about increased costs and individuals resistant to mandatory payments, has stalled policy implementation.
Much of this opposition could have been mitigated if the government had engaged in more effective collaboration and leadership from the onset.
Furthermore, communication around this policy has been opaque, contributing to public resistance and confusion.
This lack of clarity is compounded by dysfunctional coordination among intra-government stakeholders, which I’m currently researching. I will soon share recommendations on how this can be improved. Without resolving these issues, the success of SHIF remains uncertain, and many of its potential benefits may not be fully realised.
Areas of Improvement
With this anecdotal analysis of the policy in mind, my recommendations to the government that may add value are focused on ensuring SHIF succeeds where it matters most.
First, we must rethink how we collect contributions from the informal sector. A one-size-fits-all approach won’t work here. I suggest adopting a flexible, tiered contribution system where individuals contribute based on additional/enhanced benefits outlook, with options for periodic payments rather than fixed monthly contributions.
The private health insurance schemes are based on this, and many of the informal sectors are already part of it. To see the value of being part of SHIF, they must see and feel a more enhanced benefit from SHIF. This way, we ease the burden on informal workers while ensuring they remain part of the system.
Second, I suggest the government break its opaqueness and roll out a robust awareness and education campaign. I know the current communication is ongoing, but I believe it’s not yet as transparent in many aspects.
To build trust in this new system, the government needs to open up more on the contentious concerns of many Kenyans. People need to understand the benefits of SHIF clearly and trust that their contributions are being managed effectively.
Demystifying the process and ensuring every Kenyan knows how the fund will serve them is crucial. This campaign should involve local leaders and community health workers who can communicate the message in a relatable way. However, it cannot be effective if the same stakeholders entrusted with the communication and rollout are also vague on the details, as many Kenyans are out here.
Third, I urge the government to invest in efficient administrative infrastructure. I saw an ongoing issue of a central sourcing infrastructure costing 104 billion, NHIF administration marred by scandals and corruption, the transparency of the housing levy is still guarded, and eCitizen infrastructure opaqueness, among many other avenues the government has procured that are contentious and potentially corrupt.
This does not help in trusting the government with the ethical administration of the SHIF funds. The government must ensure that systems for collecting contributions and reimbursing providers are fast, transparent, and reliable.
To do this, they should consider building a digital monitoring system for public accountability on this fund and many other funds the citizens have raised as opaque.
A new scandal erupting from SHIF will severely damage trust in the system and discourage Kenyans from participating.
Finally, we need to commit to ongoing monitoring and flexibility. SHIF should not be a static policy. The government must commit and communicate openly the periodic review and adjustment mechanisms, ensuring the fund remains responsive to economic conditions, healthcare needs, and demographic changes.
This, for now, is a word of assurance from the supporting political class but is not well enshrined in the policy framework as transparently shared with citizens. One of the gaps in many government policies is its flexibility.
This majorly comes in because most policies have a perceived long-term outlook but short-term political gains in reality. We see that even in other policies like the new university students funding model.
There should be flexibility in that if there are areas where the policy isn’t working as intended, the government should be ready to pivot quickly and make the necessary adjustments.
Like in the current case where there are a few concerns from many stakeholders, there is a need to quickly regroup and address these concerns as part of the implementation mechanism.
As I close, I wish to share some concise thoughts about such policies implemented in Africa. The scale and context are not the same, but there are some positive lessons to pick and negative areas to avoid that would be valuable for our understanding as Kenyans and the government if they had overlooked some critical aspects of SHIF.
- Rwanda’s Mutuelle de Santé is one of Africa’s most successful health insurance schemes. It provides universal health coverage by pooling contributions from formal and informal workers, with the government subsidising low-income households.
Key lessons to consider are their flexibility in contributions, especially for informal workers, and the critical role of government subsidies for the poor in ensuring high enrollment and financial sustainability.
- Ghana’s NHIS, introduced in 2003, provides healthcare coverage to most of the population. Contributions are made through a value-added tax (VAT), and both formal and informal workers contribute. Key learning from Ghana is that inefficiencies and delays in claims reimbursement have challenged the system’s sustainability. This highlights the need for robust administrative capacity and timely payments to healthcare providers as a consideration of SHIF—let’s not transfer the same issues from NHIF to SHIF.
- Ethiopia introduced CBHI for informal sector workers in rural areas, funded through government subsidies and household contributions. Key learning in this scheme is that community involvement and trust-building are essential for ensuring widespread participation, especially among informal sector workers who may be hesitant to contribute to a new system.
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These examples demonstrate that social health insurance schemes can thrive and ensure universal healthcare access with the right balance of flexibility, efficiency, and government support.
While SHIF is a crucial step toward delivering healthcare for all, the government must address the practical realities that could hinder its success.
By adopting a flexible approach to contributions, investing in public awareness, ensuring administrative efficiency, and building systems for accountability, we can make SHIF work for every Kenyan and achieve our vision of Universal Health Coverage.
