Outrage over SHA policy on teenage mothers

Social Health Authority building in Nairobi. [File, Standard] The announcement by Social Health Authority Chief Executive Officer Robert Ingasira that teenage mothers will have to pay for insurance premiums has elicited mixed reactions. Ingasira revealed that expectant teenagers would be subject to a means-testing to determine if they require financial assistance from the government or not. This revelation marks a shift from the previous Linda Mama program, where all pregnant women were eligible for free maternity services, regardless of their financial ability. Under SHA, pregnant underage children will be issued with 'temporary ID' different from their parents' number within the Integrated Healthcare Information Technology System (IHTS). Through means testing, SHA will evaluate individual's financial capacity to allow the system determine their annual premium. The SHA official argues that the programme is deliberately meant to help teenage mothers and to address the gap in the previous health scheme. "The initial arrangement where teenage mothers were being identified using their mother's ID created problems for us because some had mothers who were still within the childbearing age," said the CEO during the signing of an MoU between SHA and the Murang'a County Government "So you would find issues where a mother could reportedly be said to have given birth more than twice in a year just because her ID was used for her own delivery and also for her daughter's delivery," he added However, this policy has been challenged as confusion. "How will 15-19-year-old teens pay for SHIF? They have no capacity to do so and shouldn't this demographic automatically fall under indigent populations without having to fill in the questionnaires for the means testing tool?" Posed Margaret Nyambura, an advocate for Universal Health Coverage. She argued that teenage pregnancies are already a tough situation and having the girls pay for pay for delivery will worsen their predicament. "According to the Kenya Demographic and Health Survey (KDHS) 2022,15 per cent of girls aged between 15-19 in Kenya have ever been pregnant. Just imagine these girls having to pay for their delivery," she wondered. Ingasira noted that if the teenager or their family is found to be vulnerable and cannot afford to pay premiums, the government will step in to cover costs. Under the repealed National Hospital Insurance Fund, Linda Mama used to pay for delivery. But the CEO noted that Linda Mama transformed and integrated into the universal health and that pregnant mothers will have to register as they visit the hospitals. After registration, a means testing is done to determine if the woman can pay for SHIF or if they require assistance from the government through indigent program. Under Linda Mama, the state aimed to promote and encourage women to give birth in health facilities hence improve pregnancy outcomes including maternal and neonatal deaths. It was also meant to secure household incomes meant for deliveries to other economic activities with a potential positive impact on poor households. As of 2024, number of mothers who registered through the Linda mama program were 3,580,916 and 2,532,794 deliveries were reported over the period. "So the current budget allocation we have is to help enroll pregnant mothers into this program," said Ingasira. "The benefit of the mother being paid for will benefit the entire household and it will allow the mother to get both pre and post-delivery care," he added. He said the programme also covers the whole year as opposed to Linda Mama that was just paying for delivery. Currently, the standalone health coverage scheme specifically designed for teenage mothers is being piloted in Pumwani before it is rolled out in all other contracted hospitals.

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