Sophia (not her real name) remembers the day so well, a week after the government rolled out the Social Health Authority (SHA) to replace the defunct National Health Insurance Fund (NHIF).
One of her parents had been undergoing monthly chemotherapy sessions in one of the hospitals in Kisumu, but on that day, the hospital could no longer treat her under the old government insurance scheme. It had been phased out days ago.
Brought to the hospital by her husband, Sophia’s mother felt stranded, not knowing what to do. Several questions flashed through their minds; ‘Was she going to skip this month’s chemo session? How long was it going to take to register for the new insurance scheme (SHA), get activated and finally get treated?
She was almost hopeless. She then decided to call her daughter who works in the city, to see if she could send them some money for the month’s session.
When the daughter received the news, she decided to pay for the SHA subscription immediately. She tells Business Today that the parents were taken through a short means testing session to see how much their premiums would be.
“I was sent the amount, and shockingly, it was less than the one I used to pay in NHIF. Once I paid their accounts were activated immediately and she got treated. I did not have to call anyone in any office for intervention. Everything happened instantly,” Sophia tells Business Today.
In Mombasa, 75-year-old Emily Damah Charo tells almost a similar story. Speaking to Citizen TV, Emily, a retired civil servant says getting treatment under NHIF had its own challenges.
“I’ve had a heart problem for a long time. My doctor called me recently to come to the hospital. He took me through a (medical) procedure which was fully paid for by SHA,” she told the TV station.
Her daughter who brought her to the hospital says that the procedure would have cost a lot of money if SHA did not intervene.
“The billing was done in the morning. It was a lot of money which we did not have. When we talked to the doctor she told us there is no need to worry since we are SHA members and SHA would cater for everything.”
“We never believed. When the doctor asked us to take her in we were worried who would take care of the bill but SHA paid everything.”
According to the doctor, it only took 15 minutes for them to get approval from SHA for the patient to receive treatment.
“She came in and we asked for approval for her procedure. It was approved within 15 minutes and we went in to the theatre for the procedure. As we speak she is recovering in our critical care unit doing very well. Social Health Authority has taken care of the entire bill,” the doctor said.
Camparing it to NHIF, Emily says SHA is way better since in the older scheme, NHIF did not cater for 100 per cent of the hospital bill.
“NHIF did not take care of 100 per cent of the bill. With NHIF, I had to get a letter from the doctor to fundraise for the remaining amount.”
SHA achievements
The two are among thousands of Kenyans who have received treatment from hospitals courtesy of SHA. According to the latest data from SHA, in the last one month, SHA has catered for hospitals bills of worth Ksh289 million for inpatient, Ksh162 million for dialysis care, Ksh132 million for cancer care (oncology), Ksh106 million for maternity and infant care and Ksh95 million for mental wellness.
Under SHA, there have been over 7,900 Kenyans have visited over 800 facilities for deliveries (both normal and caesarean), over 21,000 outpatients at over 2,600 facilities, over 28,000 inpatients at over 1,400 facilities, 15,800 dialysis visits at 225 facilities and 265 mental wellness visits at 95 facilities.
In the last one month, the government has enrolled 4,444 public and government facilities, 2,498 private facilities, 535 faith-based facilities, 17 community facilities and 86 other facilities.
Currently, SHA provides care through preventive, promotive, curative, rehabilitative and palliative health services. These are provided at level 4, 5, and 6 health facilities under the fund. This includes emergency services, critical care services beyond the benefits in the essential healthcare benefits package, treatment and management of chronic illnesses beyond the benefits in the essential healthcare benefits package of the Social Health Authority.
Every person resident in Kenya is required to apply for registration to the Authority as a member of the Social Health Authority.
The application must be accompanied by a copy of the national identification document or any other approved document, and for children without identification, documentation provided by the state department responsible for social protection.
