• By Raymond Momanyi

Kenya's New Health Cover: A Look at the Three Funds Under the Social Health Authority

Kenya has embarked on a significant transformation of its healthcare financing system with the establishment of the Social Health Authority (SHA). This new body replaces the long-standing National Health Insurance Fund (NHIF) and introduces a multi-tiered approach to health coverage through three distinct funds. Understanding these funds is crucial for all residents. For context, an insurance intermediary like Imana Insurance Agency Kenya Ltd, which offers a wide range of insurance products, operates within this new landscape, guiding clients on how these changes may impact their overall insurance needs.

The Social Health Authority manages the following three funds, each with a specific purpose, to ensure comprehensive health coverage for all Kenyans:

1. Primary Health Care Fund (PHCF): This fund is designed to cover the costs of preventive and promotive health services at the grassroots level. It is primarily funded by the government and aims to ensure that all Kenyans have access to essential health services at community health units, dispensaries, and health centers (Levels 1, 2, and 3 of the healthcare system). The goal is to address health issues early and reduce the burden on larger hospitals.
2. Social Health Insurance Fund (SHIF): This is the contributory fund that a majority of Kenyans will be a part of. Salaried individuals contribute 2.75% of their gross monthly income, while those in the informal sector contribute based on their assessed income. The SHIF is designed to cover a broad range of in-patient and out-patient services at Level 4, 5, and 6 hospitals. This includes consultations, surgeries, diagnostic tests, and other specialized treatments. It forms the core of the new social health insurance scheme, ensuring that members can access a comprehensive package of benefits.
3. Emergency, Chronic, and Critical Illness Fund (ECCIF): This fund is specifically set up to cushion Kenyans against the high costs associated with managing chronic diseases, critical illnesses, and emergency treatments. It is funded through government appropriations and is intended to provide relief for conditions that can be financially catastrophic for families, such as cancer, kidney failure requiring dialysis, and emergency medical situations.

For individuals and businesses navigating this new system, insurance intermediaries like Imana Insurance Agency Kenya Ltd can provide valuable guidance. While the SHA provides the foundational public health coverage, private insurance still plays a critical role. Imana Insurance Agency can assist clients in understanding the benefits and limitations of the SHA schemes and can help in securing additional private health insurance to cover any gaps or to access a wider range of healthcare providers and services. They can also advise on other essential insurance covers such as professional indemnity, WIBA (Work Injury Benefits Act), and motor insurance, ensuring a comprehensive safety net for all aspects of life and business.