The 2.75 per cent Social Health Insurance Fund (SHIF) deductions are set to begin this month.
Changes outlined in the Social Health Insurance Act, of 2023, are expected to affect previously established health systems such as Linda Mama and Edu Afya.
Replacing NHIF
According to Health Cabinet Secretary Susan Nakhumicha, SHIF will replace the National Health Insurance Fund.
The CS explains that SHIF will now come in as a reaction to the pressing need for accountability, a sentiment that the government has supported.
The Social Health Insurance (General) Regulations, 2024 has repealed NHIF and established three new funds: the Primary Healthcare Fund, the Social Health Insurance Fund, and the Emergency, Chronic and Critical Illness Fund.
Nakhumicha explains that the Primary Healthcare Fund will cover services at Levels 1 through 3 hospitals, the Social Health Insurance Fund will pay for services at Levels 4 through 6, and so on.
The Emergency, Chronic, and Critical Illness Fund will pay for services once social health insurance is exhausted.
2.75 per cent of each citizen's salary is anticipated to go toward the health fund.
Kenyans without jobs will now pay Sh300 to NHIF on a tiered basis depending on their ability to contribute, instead of the Sh500 they were previously paying each month.
The government is then expected to cover medical insurance expenses for vulnerable Kenyans unable to make the Sh300 contribution.
Phasing out EduAfya
The government stopped the EduAfya program insurance cover for learners last year, triggering widespread outcry among parents and students.
According to CS Nakhumicha, the Sh4.6 billion allotted for the program will now be moved to the Primary Healthcare Fund, where students and their families will be covered.
The EduAfya Medical Scheme became effective in May 2018 following a directive from former President Uhuru Kenyatta and it covered learners in public secondary schools across the country.
Through the cover, the government paid a premium of Sh1,350 per student.
It was facilitated by the Ministry of Education through the Free Day Secondary Education which paid premiums for over 3.4 million learners.
As she explained why the EduAfya Medical Scheme has to be phased out, Nakhumicha said that since it makes no sense to insure a student who comes from a family but leaves the rest of the household uninsured, all students will be covered under their households.
Replacing Linda Mama
Former President Uhuru started the free maternity initiative dubbed Linda Mama in 2016.
It was a publicly funded healthcare scheme launched by NHIF.
President Uhuru Kenyatta came to office in 2013 and removed all user fees for delivery at state healthcare facilities, and free maternity services were implemented.
Subsequently, the Ministry of Health would compensate medical facilities for the money they had lost.
However, because the ministry lacked a beneficiary registration to validate provider claims, this structure was marred by inefficiencies and fraud.
In 2016, the program was consequently moved to the NHIF and given a new name: the Linda Mama program.
The Social Health Insurance Fund, according to CS Nakhumicha will cover maternal and child clinics previously done by the Linda Mama programme.
Other services covered by SHIF include; screening, drug rehabilitation, mental health support, physiotherapy, CT scans, MRI and PET scans, X-rays, brachytherapy, outpatient and inpatient services, HIV testing, cancer screening, family planning, surgeries, emergencies, including ambulance services, cardiac arrest, accidents and even transplant procedures.