Ministry backs new medical scheme: Is it all hype and hot air?

President William Ruto speaks after assenting Universal Health Care Bills at State House, Nairobi, in October 2023. [PCS] What the Kenya Kwanza government has been pushing into the faces of Kenyans as a shining success of its term now lies in near ruins. Like a shattered mirror that leaves the owner bleeding while staring at their broken reflection, the government is now confronted with a new Social Health Authority (SHA), whose providence is nothing but pain, frustration, and, possibly, unspoken deaths for thousands of Kenyans, whose plight it was meant to alleviate. On Wednesday, when a section of patients stormed Afya House to express their consternation and pique, Health Cabinet Secretary Deborah Barasa must have been caught by surprise. She offered a feeble apology herself, not on behalf of the authority. It was all blamed on the system's downturn. Kenyans have been poking holes in the new scheme, stating that deductions capped at 2.75 per cent of gross income are not commensurate with the services received. Amid this public uproar, Principal Secretary for Medical Services, Harry Kimtai, maintains that the SHA system marks a significant improvement over the defunct National Hospital Insurance Fund (NHIF). Speaking to The Saturday Standard, the PS explained that while patients at Kenyatta National Hospital received treatment, the system went down during their discharge on January 14. "When the system went down, the technical team discovered that there were a lot of requisites being processed, which jammed the system. This was worked on overnight, and by January 15 at 10.30 pm, the system had picked up. ''The backlog was cleared, and the system is currently working well," said Kimtai. He added that the team had achieved an operational efficiency of 68.7 per cent, which fell short of the expected target of 95 per cent. "The delay was minimal, operating at 68.7 per cent efficiency due to the high volume of patients being served at the national hospital. It was a matter of traffic, and we had to open up the system to ensure multiple attempts by users did not interfere with its functionality." He noted that facilities with high patient volumes are more likely to experience traffic, which could delay patient discharges. "No one missed out on services. The delays occurred during the billing process when patients were being cleared. The system requires coordination between the health facility and SHA to ensure proper authorisation of payments-for instance, verifying what is due and payable before a patient can be discharged," he stated. He further clarified that payments processed through the employer portal differ from those handled via the claims portal. "When processing claims, authorisations are necessary to verify that the requisite approvals were obtained prior to treatment. The system checks various factors. Bulk processing, where employers send a list of employees and deductions, operates differently from processing individual claims," he explained. There have also been complaints about Kenyans across the country not accessing outpatient services, mostly offered at Level 2, 3, and 4 hospitals, compared to those seeking critical care, like those battling cancer. According to Kimtai, there have been no complaints regarding outpatient services. [Mercy Kahenda] .He explained that individuals seeking services at Level 2 and 3 hospitals should be able to register with SHA, to get free care, while those visiting Level 4 and 5 must pay for services under Social Health Insurance Fund (SHIF). "Anyone seeking primary care in Level 2, and 3 hospitals does not pay, but must be registered members of SHA. At Level 4 and 5, you must pay as a member- the system checks to confirm if you have paid your premiums. The system, checks legibility and then access services," he explains. SHA has three distinct funds namely the Primary Healthcare Fund, the Social Health Insurance Fund (SHIF), and the Emergency, Chronic, and Critical Illness Fund. The Primary Healthcare Fund and the Emergency, Chronic, and Critical Illness Fund-are financed by the exchequer, whereas SHIF is funded through individual contributions, capped at 2.75 per cent of gross income. The Primary Healthcare Fund provides services at Level 2, 3, and 4 facilities, such as dispensaries and health centers, while SHIF, on the other hand, supports services at Level 4, 5, and 6 hospitals. For individuals who deplete their SHIF benefits, the Emergency, Chronic, and Critical Illness Fund offers additional support for care, particularly at Level 6 hospitals. At the moment, the PS said the only problem reported with SHA is in treatment of chronic patients, more so those in ICU. "The only problem with chronic, is those in ICU for example at the moment because there is a problem with Finance, we are still paying a requisite of Kshs 4,600," the PS explained. In a separate earlier interview with this paper SHA Acting Chief Executive Officer (CEO) Robert Ingasira acknowledged some of the hitches reported at the scheme, and promised to have them handled.

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