- While SHA Chairman Abdi Mohammed argues that the scheme embodies equity by having higher earners subsidise lower earners, this argument falls flat when confronted with the reality of the low benefit caps.
- With allocations of Sh11,200 for normal deliveries and Sh32,600 for Caesarean sections, SHA appears to be operating in a parallel universe, detached from the realities of healthcare costs in Kenya.
- As we stand at this crossroads in Kenya’s healthcare journey, we must heed Achebe’s implicit warning about the dangers of accepting seemingly benevolent systems without critical examination.
In his seminal work “Things Fall Apart,” Chinua Achebe wrote: “The white man is very clever. He came quietly and peaceably with his religion. We were amused at his foolishness and allowed him to stay. Now he has won our brothers, and our clan can no longer act like one.”
While Achebe was addressing colonialism, his words resonate with the current situation in Kenya’s healthcare system. The Social Health Authority (SHA) scheme, introduced with promises of universal coverage and improved health outcomes, may be unraveling the very fabric of healthcare it aimed to strengthen.
Kenya’s journey towards universal health coverage has been marked by ambitious policies and grand visions. The Social Health Authority (SHA) scheme, that has been rolled out, stands as the latest beacon of hope in this pursuit.
However, as we peel back the layers of this initiative, we find a tapestry of good intentions marred by questionable execution and potentially dire consequences for the very people it aims to serve.
At the heart of the SHA scheme lies a fundamental misalignment between contributions and benefits. The scheme requires citizens to contribute 2.75% of their income, a figure that many experts argue is disproportionate to the benefits offered.
James Kamau, a respected health economist, points out glaring discrepancies in the allocations for essential services. For instance, the annual cap of Sh2,000 for dental services per household seems almost laughable when considering the actual costs of dental procedures in Kenya.
Perhaps most concerning is the scheme’s approach to maternity care. With allocations of Sh11,200 for normal deliveries and Sh32,600 for Caesarean sections, SHA appears to be operating in a parallel universe, detached from the realities of healthcare costs in Kenya.
At Kenyatta National Hospital, a C-section can cost up to Sh150,000 in the private wing and Sh50,000 in the general wing. This vast disparity raises a crucial question: How can SHA claim to offer meaningful financial protection when its benefits fall so short of actual healthcare costs?
The roots of this misalignment can be traced to what appears to be a lack of robust market analysis. Prof. XN Iraki from the University of Nairobi raises a pertinent point when he questions whether proper stakeholder consultations were conducted. The absence of a clear, data-driven rationale for the set tariffs undermines confidence in the scheme’s design and raises suspicions about the motivations behind its structure.
Paradoxically, a scheme designed to reduce catastrophic health expenditures may end up increasing out-of-pocket spending for many Kenyans. As health economist John Juma warns, individuals may need to pay additional costs once their cover is exhausted or if the actual cost exceeds SHA’s limits.
This situation could negate the financial protection that universal health coverage aims to provide, leaving Kenyans in a precarious position where they are paying into a system that fails to meet their needs.
While SHA Chairman Abdi Mohammed argues that the scheme embodies equity by having higher earners subsidise lower earners, this argument falls flat when confronted with the reality of the low benefit caps.
The “one-size-fits-all” approach to benefits, while administratively simpler, fails to address the diverse health needs across different socioeconomic groups in Kenya. It’s a stark reminder that equity in healthcare goes beyond mere financial contributions; it must translate into meaningful access to quality care for all.
The impact of SHA’s low tariffs extends beyond individual citizens to healthcare providers themselves. An anonymous private hospital owner voices concerns about whether services included in the package will be guaranteed payment. This uncertainty could lead to a reluctance among providers to participate fully in the scheme, potentially limiting access to care and undermining the very goal of universal coverage.
Moreover, the discrepancy between contributions and benefits raises serious questions about SHA’s long-term financial sustainability. If the scheme consistently pays out more in benefits than it collects in contributions, it may face financial strain over time, potentially leading to benefit reductions or increased contribution rates – a lose-lose situation for Kenyan citizens.
While SHA does introduce coverage for services like dental and optical care that were previously unavailable to many Kenyans, the low caps on these services may limit their practical value. This highlights a broader concern about whether the scheme truly offers comprehensive coverage that meets the population’s health needs or merely provides the illusion of coverage.
As with any major health system reform, SHA faces significant implementation challenges. The success of the scheme will depend heavily on effective management, efficient claims processing, and the ability to adapt to emerging issues. These operational aspects are crucial but often overlooked in policy discussions, leaving room for potential systemic failures.
Perhaps most insidiously, there’s a risk that the low benefit caps could inadvertently incentivise healthcare providers to prioritise quantity over quality of care, or to focus on services with higher margins. This could lead to suboptimal health outcomes and reduced patient satisfaction, further eroding trust in the healthcare system.
The concerns raised by various experts and stakeholders may erode public trust in SHA before it’s fully implemented. Without strong public buy-in and participation, the scheme may struggle to achieve its goals of universal coverage and improved health outcomes.
In conclusion, while the intention behind SHA to provide universal health coverage is commendable, the current structure of the scheme raises significant concerns about its effectiveness and value for Kenyan citizens.
The misalignment between contributions and benefits, coupled with questions about market research and stakeholder engagement, suggests that substantial revisions may be necessary to make SHA a truly worthwhile initiative for improving healthcare access and outcomes in Kenya.
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As we stand at this crossroads in Kenya’s healthcare journey, we must heed Achebe’s implicit warning about the dangers of accepting seemingly benevolent systems without critical examination.
The SHA scheme, introduced quietly and peaceably with promises of universal coverage, may be winning over some brothers and sisters. But as a clan – as a nation – we must act as one to demand a healthcare system that truly serves all Kenyans.
The clever promises of SHA must be met with even cleverer scrutiny, lest our healthcare system fall apart under the weight of well-intentioned but poorly executed policies.
The writer is a lawyer and legal researcher
