New Social Health Authority to cover HIV treatment, says ministry

Kenyans living with HIV will now access more free services through the new health authority, shielding them from shifts in donor funding.

Donors mainly fund ARVs, but people with HIV also need other drugs such as septrin and testing.

Health CS Susan Nakhumicha said these will be covered by the Social Health Authority, which will be rolled out next month.

“It is important to note that HIV care is included in the package even as the transition of financing models is discussed,” she said.

“The great news is clients at the centre for NCDs and advanced HIV disease are captured under this new model. I urge all our people living with HIV to enrol and be members of SHA.”

Kenya has an estimated 1.4 million persons living with HIV, translating to a national prevalence of 3.7 per cent.

The Ministry of Health says 1,336,234 people living with HIV (PLHIV) were receiving treatment by December 2023.

The National Syndemic Diseases Control Council says drugs cost Sh25 billion every year and are mostly paid for by donors.

Nakhumicha also said many PLHIV are now ageing and are more susceptive to non-communicable diseases, compared to people without HIV.

“The quality of life for PLHIV on long-term treatment is an emerging concern, particularly due to the increased risk of non-communicable diseases and mental health needs.

“Addressing these issues requires a holistic, patient-centred, and integrated approach,” she said during the just-ended HIV Service Delivery Integration Summit.

It was organised by the National STIs Control Programme (Nascop).

The SHA benefits package shared by the ministry will offer screening for non-communicable diseases without co-payment in dispensaries up to Level 4.

The CS said HIV health services will no longer be isolated and clinics will now be combined with those offering related services not covered by donors.

“Specifically, for clients whose needs span beyond HIV, such as those with NCDs such as hypertension and diabetes, the virus-only tragedy-specific care leads to suboptimal outcomes and non-responsive client experience,” she said.

“The isolation and specialised labelling of stand-alone HIV comprehensive care clinics further contributes to stigma and discrimination within health facilities.”

Kenya has 3,752 HIV treatment sites encompassing public, private, and faith-based organisations-supported facilities.

The ministry said more than 90 per cent of people living with HIV receive care at Level 2 to Level 4 health facilities.

“Specifically, 21 per cent of PLHIV are cared for at Level 2 facilities, 27 per cent at Level 3 facilities, and 45 per cent at Level 4 facilities,” Nakhumicha said.

The new Social Health Authority will replace the NHIF from next month.

Every Kenyan household will pay 2.75 per cent of its income to the fund every month, as soon as it is rolled out.

It projects to collect at least Sh148 billion every year to fund improved services.

The projected collections double the annual collections by the National Health Insurance Fund, which raised Sh82.1 billion in 2022-23 and paid out Sh74.2 billion in claims.

“The yield we expect in one year is about Sh148 billion, although it might vary depending on how Kenyans in the informal sector contribute,” Medical Services PS Harry Kimtai said last week.

Kenyans who are not in formal employment will fill out a questionnaire to determine their annual income. They will then pay 2.75 per cent of this income, but not less than Sh300 every month.

SHA will have three funds, with the primary healthcare fund paid for by the government.

This fund will cover services offered by community health practitioners and in dispensaries and health centres.

These are basic services such as screening for diseases, lab tests and dispensing of some medicines.

Kimtai said they project the government will need to put in Sh8 billion every year to PHC for these services.

“All Kenyans seeking health services must enter the health system through the PHC, after which they will be referred to the level 4 and 5 facilities, if necessary,” he said.

Services in Levels 4 and 5 will be paid for through the second fund — the Sh148 billion Social Health Insurance Fund — for which Kenyans are paying 2.75 per cent of their income.

Nearly all services paid for through SHIF are capped. For instance, the benefits package shows hospitalisation is only for 50 days maximum.

Sick people who exhaust these limits can apply for more financing to the third fund known as Emergency, Chronic and Critical Illnesses Fund.