Questions over SHIF deductions versus benefits as pain for patients continues

Social media platforms and workplace discussion groups are flooded with Kenyans expressing their frustration at what they see as excessive pay cuts.

Since the transition from the National Health Insurance Fund (NHIF) to the SHIF on October 1, the new system has come under intense scrutiny. Some Kenyans have shared about their challenges, while others have expressed skepticism that they will receive sufficient healthcare benefits in return.

While the government has promoted SHIF as a long-term solution to improve access and affordability to healthcare, Kenyans are unsure whether the financial sacrifices will be met with adequate health coverage.

Under the now defunct NHIF, the maximum contribution was capped at Sh1,700. However, under the new Social Health Authority (SHA) individuals are now required to contributes 2.75% of household incomesteep growth that squeezes already strained finances.

Many employees feel that deductibles are a high price to pay without clear guarantees of quality healthcare.

A parent, Annastia Akinyi, he spoke to Sunday Nationsaid it is expensive to find disabled children because of the high cost of medication.

“It’s very upsetting. Most medications for children with disabilities are not covered by this insurance. You pay cash. We would expect that the deduction from the SHA, which is so large, would instead have gone towards the purchase of drugs. You wonder how people who need these drugs are expected to get them,” Mrs Akinyi said.

She said that after the SHA came into effect, there was a drastic cut in her salary from October.

“The amount deducted is more than half of what I spend on my daughter’s crucial medication that she has to take daily and is not covered by insurance. How should we take the medicine?” she asked.

“We need to be told how we will get the medicine. Why should we be deducted such a large sum but our children cannot have access to vital medicines? The money that is deducted is enough to pay for my daughter’s medicine,” she added.

Pheobe Ongadi, executive director of the Kenya Network of Cancer Organisations, said that when the SHIF was launched, patients had high expectations that they would receive extensive benefits. But so far, it’s been a disappointment, she said.

“Unfortunately, to our disappointment, SHIF has made our patients suffer. They went through a lot of pain. We have received calls from stranded patients who are still being asked to pay for treatment in advance. Cancer treatment is very difficult and challenging. We should not subject them to such trauma,” said Ms Ongadi, whose organization has 62 registered groups.

She urged the government to close gaps in the transition to prevent further deterioration of the health and well-being of cancer survivors, as cutting off essential services is a violation of their right to health and life.

“Cancer treatment is a race against time and the longer we put treatment on hold, the more complicated it will be in the future to treat the disease,” Ms Ongadi said.

She also asked for clarity on the reimbursement that SHIF gives to hospitals after cancer treatment.

“When you looked at the National Health Insurance Fund, it was very clear that it was remitting Sh25,000 per session for chemotherapy, but now for SHIF, patients are asked to add half the money for the treatment. Can SHIF be clear about the quantity and sessions for cancer treatment,” the official said.

“It may be one of the best decisions, but the transition and the planning was rushed and at the end of the day, a lot of people are affected,” she added.

National Cancer Institute chief executive Dr Elias Melly said they recognize patients face problems.

“We are having serious discussions in the Ministry of Health to see how the 400,000 lei allocated for cancer treatment can be increased. The fund available for treatment might not be adequate for some types of cancer, but the amount might be enough if someone gets treatment in a public facility,” he said.

“The amount will be revised. We will make decisions about the best way to address issues so that patients can receive treatment. There is hope,” he added.

A teacher in Nairobi, Sarah Wambui, said she now has less money for daily expenses following the SHIF deductions but does not know what benefits she will receive under the new health scheme.

Other Kenyans have expressed concern about the timing of SHIF implementation. With inflation rising and a challenging economic landscape, many argue that these new deductions only add to the financial burden on households already struggling to make ends meet.

“It feels like an additional tax, but there is no clear plan as to how it benefits us. We need to know that our money is being used well. Otherwise, we are just financially exhausted with little to show for it,” said Peter Omondi, a worker at a retail shop in Kisumu.

The Ministry of Health and the government have defended the SHIF plan, explaining that it is a necessary step towards ensuring universal healthcare coverage for all Kenyans.

Since the launch of the SHA, they have emphasized that once fully implemented, it will provide a more comprehensive healthcare package covering essential treatments and consultations in both public and private hospitals.

To address public concerns, the government promised to establish a transparent reporting mechanism detailing the impact of SHIF on health service delivery. However, complaints about challenges facing the new health plan continued.