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The Social Health Authority (SHA) benefits are not commensurate with the 2.75 per cent deductions it imposes on contributors’ payslips.
According to the nurses’ union and welfare body, SHA implementation has also fallen short, with many promised services failing to materialise.
This is despite the SHA benefits package being considered superior to the defunct National Health Insurance Fund (NHIF).
The Kenya National Union of Nurses and Kenya Nurses Association state that SHA’s failure has left most Kenyans struggling to access healthcare.
KNUN and KNA further say that some Kenyans are now forced to pay out-of-pocket for essential services.
KNUN Secretary General Seth Panyako has attributed the failure to deliver services to corruption within the agency.
“SHA is not delivering what it should because of corruption,” said the nurses’ representative.
“The benefits under SHA are far superior to those of the NHIF, but corruption has compromised the scheme.”
Panyako further noted, “Yes, the SHA package looks great on paper, but the main issue is that what’s documented is not what’s being offered. Under NHIF, we paid less but were satisfied with the services.”
Deductions under SHA are capped at 2.75 per cent of one’s gross pay.
The minimum pay to the SHA scheme is Sh300, compared to Sh500 under the defunct NHIF
Maximum deductions under NHIF were Sh1,700 a month, which was mostly enjoyed by civil servants under comprehensive health cover.
In the SHA benefit tariff, Sh11,200 is allocated for normal deliveries and Sh32,600 for Caesarean Sections (C-Sections).
Under NHIF, the government used to remit Sh2,500 for normal deliveries under the Linda Mama programme, whereas C-Sections were allocated Sh5,000.
Despite health officials maintaining that SHA also has the Linda Mama programme, hundreds of mothers are reported to be detained in hospitals.
With increased cases of cancer, SHA allocates Sh5,000 for administering chemotherapy, while Sh10,650 is allocated for dialysis for patients with kidney failure.
Dental services are included in the SHA package, including Sh500 for mortuary fees per day.
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Tooth extraction has been allocated Sh650, dry socket debridement Sh750, and atraumatic restrictive treatment Sh1,000.
Other dental allocations include Sh1,000 for suturing procedures, Sh300 for screening and consultation, and Sh1,200 for gingivitis and periodontitis treatment by scaling and polishing.
Under the dental package, NHIF provided a benefit of Sh60,000 per year, but only civil servants benefited, while other contributors had no dental cover.
But even with enhanced packages in the SHA scheme, many Kenyans have complained of not receiving the services.
Panyako urged the Ministry of Health to streamline SHA to allow Kenyans access to quality healthcare.
Nurses are further demanding the reinstatement of a comprehensive cover that was offered to all civil servants under NHIF.
The president of the Kenya National Nurses Association, Collins Ojwang, said the transition from NHIF to SHA without a proper transition framework has aroused frustration among nurses and other healthcare workers.
Ojwang said there is a need to have comprehensive health coverage for nurses, who are a critical component in the delivery of healthcare services in Kenya.