The Social Health Act was enacted in 2023 and led to the establishment of the Social Health Authority (SHA), which took effect in October 2024. SHA aims to provide accessible, affordable, and equitable healthcare services to all Kenyans, supporting the Universal Health Coverage (UHC) agenda.
The Social Health Authority is established to pool all contributions made under the Act, purchase healthcare services from empanelled and contracted healthcare providers, and pay for quality healthcare services to beneficiaries.
How Do I Register For SHA?
The subscription is made through the USSD code *147# or through the Afya Yangu website: www.afyayangu.go.ke.
How are Monthly Payments Determined?
The payments are determined through means-testing to establish individuals’ contribution capability. Self-employed people can pay as low as Kes . 300 a month, while salaried individuals pay 2.75% of their monthly salary through statutory deductions.
What about SHIF and the others?
There are three funds under SHA:
- the Primary Health Care Fund,
- the Social Health Insurance Fund (SHIF),
- and the Emergency, Critical, and Chronic Illness Fund (ECCIF).
The primary Health Care Fund
The primary Health Care Fund is directly financed by the Kenyan government. It funds health care services available at Levels 1, 2, 3 and select Level 4 hospitals. SHA seeks to facilitate the optimum use of lower-level health facilities.
SHA does not fund Primary Health Care at levels 4, 5, and 6 of the Social Health Authority care facilities.
However, if receiving primary health care at lower levels, one can be referred to higher level health care facilities, for instance, a level 6 hospital for Essential laboratory investigations of diabetes, cardiovascular, sickle cell, and chronic pulmonary/asthmatic diseases, which are partially paid by the Social Health Insurance Fund (SHIF). After the tests, the patient is supposed to return to treatment at a level one, two, or three health facility.
The Social Health Insurance Fund (SHIF)
The Social Health Insurance Fund (SHIF) is funded by member contributions and pays for various services at levels 4, 5, and 6 hospitals, including radiology, inpatient treatment, surgical, dialysis, and oncology. Salaried and self-employed persons can join the Fund.
The Social Health Authority fully covers PET Scans and PSMA (Prostate-specific membrane antigen positron emission tomography) scans. For oncology services, diagnostic tests are allocated Kes. 100,000, while treatment is Kes. 300,000 per person, amounting to Kes. 400,000 per person per year.
SHA vs NHIF
The SHA differs from the NHIF in that it pays up to Kes. 300,000 for cancer treatment, while the NHIF used to pay partially per session, up to 6 sessions. This means one had to top up for each session and fully pay for any sessions after the sixth one.
SHA’s benefits increased 12% above the NHIF payments.
Under SHA, cardiology surgery patients (open heart surgery) receive an allocation of Kes. 952,000, up from the maximum of Kes. 450,000 offered by the NHIF.
Kidney transplants were fixed at Kes. 480,000 under NHIF, but SHA is catering for the recipient’s surgery, donor nephrectomy, post-renal replacement therapy, and pre-transplant evaluation. Post-renal replacement therapy costs have been a hindrance to transplant candidates.
Under SHA, there is also the Emergency, Critical Care, and Chronic Illness Fund, which is funded through taxes. This fund is a remedy for the past scenario, where patients would reach a limit after which they would have to top up.
Learn more about the Emergency, Critical, and Chronic Illness Fund (ECCIF).
NHIF did not cover cancer diagnosis; it only covered screening and treatment. SHA covers the cost of consultation, preventive, and restorative treatments such as extractions, scaling, and infection management.
Use SHA in KU Hospital
Being a level 6 Hospital, KUTRRH is well aligned. It accepts Emergency cases for Kenyan residents for 24 hours, after which the patient is required to migrate to SHIF.
For any enquiries, one should contact KUTRRH toll-free number 1558 or + 254800721038 or through email to customercare@kutrrh.go.ke