SHIF enrolment falls short of 15 million target amid legal, logistical hurdles

The government has revealed that only 464,263 Kenyans have signed up for the Social Health Insurance Fund (SHIF) in the first 30 days of its mass registration campaign, which began on July 1, 2024.

The figure, however, is significantly below the ambitious target of 15 million set by President William Ruto, who has championed the SHIF as a cornerstone of his legacy project for Universal Health Coverage.

The SHIF initiative, now mandatory for all Kenyans, aims to surpass the existing National Health Insurance Fund (NHIF) membership, which stands at 14 million. However, progress has been hampered by several obstacles.

In a statement on Tuesday, Medical Services Principal Secretary Harry Kimtai said one of the main challenges facing SHIF was the multiple court cases challenging its legality.

On July 12, 2024, the High Court ruled the SHIF unconstitutional due to insufficient public participation, granting Parliament 120 days to amend the legislation.

In addition, delays in procuring the necessary ICT systems and difficulties in developing health benefits packages that accommodate all stakeholders have further complicated implementation.

Kimtai also emphasised the challenge of financing, noting that the SHIF's revenue heavily depends on the informal sector, which is volatile.

“The financing is heavily dependent on the informal sector (>70% of the revenue), which is volatile. Despite the interventions like premium financing, the Authority will still be exposed to adversity in the initial phases,” he said.

Reaching out to Kenyans who lack power and internet connectivity was another difficulty, according to Kimtai.

Despite these issues, he assured that system procurement is progressing and that 7,876 healthcare providers have been enlisted on the Social Health Authority (Sha) website.

Regarding the benefits package, Kimtai revealed that the tariff has been approved by the Sha board and is awaiting national validation, expected in early August.

Furthermore, he said the transition committee, appointed on January 26, 2024, has completed its work and will submit its report by August 8, 2024. This committee was tasked with developing a clear plan for transitioning from NHIF to SHIF.

The Social Health Insurance Act was officially gazetted on March 8 paving the way for its implementation.

These regulations required all Kenyan households, non-Kenyan residents, national and county governments, and employers to register as members of the SHIF with the Social Health Insurance Authority (SHIA).

The Act has been at the centre of controversy with the Kenya Medical Practitioners and Dentists Union (KMPDU) faulting the government for pressing on with its implementation without engaging stakeholders.

In January, the Court of Appeal granted the government reprieve after former Health Cabinet Secretary Susan Nakhumicha moved to the Court of Appeal, claiming that many Kenyans had been refused access to medical care in violation of the High Court’s judgment, which was against the provisions of the Constitution.

“We hereby suspend the orders of the High Court restraining the implementation and or enforcement of The Social Health Insurance Act, 2023, The Primary Health Care Act, 2023 and The Digital Health Act, 2023,” ruled the appellate court.