Confusion as top officials snub SHA digital demonstration event

An event organised on Friday by the Ministry of Health and three companies involved in the Social Health Authority (SHA) digitisation technology, failed to take off after top officials from the ministry were a no-show.

The invite from the ministry through the communication department had indicated that the three companies – Safaricom, Apeiro Limited and Konvergenz Network Solutions – would take members of the Fourth Estate through what Kenyans should expect from the beginning of October and how the new system will work.

The Permanent Secretary in charge of Medical Services, Harry Kimtai, was expected to issue the keynote address.

But as journalists enjoyed some sumptuous breakfast in the decked hall where the event was slated to be held at the Marriot Hotel, the event’s Master of Ceremony (MC), later announced that the PS had been held up in another meeting, hence would not be available.

Adding to the confusion, representatives from Safaricom, Apeiro, and Konvergenz—the consortium contracted to provide the Integrated Healthcare Information Technology System (IHITS)—were also notably absent.

This comes as the rollout date for the new Social Health Insurance Fund (SHIF) draws near.

The appointment of the three companies to offer the digital infrastructure has drawn mixed reactions from Kenyans, with many asking the rationale behind the decision without public participation. It is even more interesting even as it emerges that two of the companies are as young as two months since being registered.

With the official launch just days away, the unexpected absence of top Ministry of Health officials is casting a shadow over this ambitious initiative aimed at achieving Universal Health Coverage (UHC).

Meanwhile, confusion and technical challenges are leaving many Kenyans skeptical about the implementation of the new health scheme, which kicks off in two days.

Investigation by The Standard into the registration process has revealed a host of issues plaguing the official website. Attempts to register encountered numerous obstacles, including system buffering for too long, invalid email alerts despite correct input, and inconsistent access to user details.

These technical glitches raise serious questions about the readiness of the digital infrastructure supporting this ambitious healthcare program.

One of the most pressing concerns is the seeming inability of the system to accommodate urban dwellers. The portal appears to automatically select upcountry health facilities based on one’s national Identification Card information, hence limiting access to services for those living in urban areas, who now live away from their rural or ancestral homes.

This oversight could significantly impact a large portion of Kenya's population and contradicts the program's goal of universal healthcare access.

Further complicating matters, the registration process seems to exclude foreign residents and refugees, despite the presence of options for these groups on the portal.

This exclusion raises questions about the comprehensiveness of the programme and its alignment with Kenya's obligations to provide healthcare for all residents, regardless of nationality.

Data protection has emerged as another major concern. The registration process requires users to input extensive personal information, including details about their place of origin and gross income. Many Kenyans are wary about sharing such sensitive data, especially given the technical issues observed on the website and the many cases of fraud.

The government has yet to adequately address these privacy concerns, leaving citizens to wonder about the security measures in place to protect their personal information.

The rates of deduction and the overall implementation process remain vexing.

With the Ministry of Health's silence on these matters, Kenyans are still in the dark about how the new system will impact their finances and healthcare access.

Despite these challenges, the government continues its campaign to register more people in the Social Health Authority (SHA) scheme. However, progress has been slow, with only less than 2.5 million Kenyans registered so far. This low registration rate remains a concern as the date to the rollout of the medical plan draw nigh.

At the heart of the debate are concerns about whether the deductions under the new scheme will correspond to the quality and extent of services provided.

James Kamau, a health economist, claims there has been no proper evaluation of market rates. He questions the allocation for dental services and deliveries, saying the amounts are insufficient.

Under the scheme, dental services are capped at Sh2,000 per household, with specific allocations for various procedures. For deliveries, the scheme allocates Sh11,200 for normal deliveries and Sh32,600 for Caesarean sections. Each delivering woman’s stay in hospital is also capped at one day.

"Allocating Sh2,000 per household and the rates for deliveries are insufficient," says Kamau. He notes that the market rates for hospital deliveries start at around Sh80,000, making the scheme's provision seem minimal. The Sh32,600 rate for C-sections, Kamau adds, would only cover a medical officer with one or two years of post-internship experience. At the Kenyatta National Hospital, C-sections range between Sh100,000 and Sh150,000 in the private wing, and up to Sh50,000 in the General Wing.

Prof XN Iraki, an economist at the University of Nairobi, questions whether the government conducted thorough market research, urging the release of stakeholder consultation results. "The charges do not seem to align with the benefits, especially when benchmarked against local and global best practices," Prof Iraki told The Standard.

However, SHA Chairman, Abdi Mohammed, insists that market research was conducted before setting the tariff benefits. The benefits, he says, were based on projected collections versus risks, sustainability, and prioritised needs. Dr Mohammed points out that the benefits suit public hospitals, where most Kenyans seek care. Even with criticisms of the dental and optical allocations, he emphasises that these services were not previously covered by the National Hospital Insurance Fund (NHIF).

"This is a start," says Dr Mohammed, explaining that SHA is a universal and social health insurance scheme that pools risks and funds from the entire population to prevent catastrophic health expenditures. "The principle is to pool funds together, and the government steps in to assist the poor. The focus is on catastrophic health risks, and we prioritize those," he adds.

Under SHA, a person contributing Sh300 monthly is guaranteed three dialysis sessions per week at Sh10,650 per session. Without this equity, the individual might not receive care, he explains.

"The poor will benefit the most from SHA. Currently, those earning Sh40,000 and below pay more to NHIF. Under SHA, their deductions will be lower—this is equity. A lower earner pays less, while a higher earner pays more," Dr Mohammed stresses.

SHA has also standardised services across all hospitals. "No one will receive extra benefits over others. Under NHIF, government employees had superior benefits and could access more services. That will no longer be the case under SHA," says the SHA chairman.

Despite these assurances, concerns persist about the scheme's ability to deliver quality healthcare. Dr. Brian Lishenga, National Chairperson of the Rural Private Hospitals Association of Kenya (RUPHA), says the association has allowed the Ministry of Health to implement SHA.

"Our current approach is to let the Ministry implement SHA and then assess the results," says Dr Lishenga. He adds, "Ultimately, Kenyans will determine whether SHA is working for them or not."