Home » Media Centre » Blogs » Will the shift from NHIF to SHIF result in a significant change, or will it be a case of "same monkeys, different forest
The debate surrounding Kenya's transition from National Health Insurance Fund (NHIF) to Social Health Insurance Fund (SHIF) centres on the question of whether a mere change in the institutional framework will be enough to improve healthcare accessibility and affordability in Kenya
The (NHIF) has long been Kenya’s primary vehicle for providing health insurance to its citizens, particularly for low-income earners. However, the NHIF was marred with criticism for inefficiency, corruption, and coverage gaps. For example, it often failed to cover essential services like outpatient care or emergency services for many citizens who religiously paid monthly premiums for the ever-elusive coverage. Meanwhile, stories of hundreds of millions from the fund getting lost because of “typing errors” found their way into the front pages of the Dailies.
One of the most memorable corruption cases tied to the fund involved the loss of Ksh 21 billion through fake claims. Health providers allegedly colluded with NHIF officials to submit fraudulent claims for services that were never rendered. Investigations unearthed a scheme that revealed some private hospitals and clinics were claiming reimbursements for non-existent medical treatments.
Further, several NHIF procurement processes were riddled with irregularities. For example, tenders for medical equipment and IT systems were overpriced, and contracts were awarded to companies that did not meet the required standards. This has over the years led to massive financial losses within NHIF.
The numerous fraudulent cases and allegations of corruption within NHIF exposed systemic weaknesses, stirring uproar among Kenyans and prompting the government to institute the establishment of what has grown to be known as the SHIF – which was part of the sitting government’s agenda to achieve its set goals on access to universal health care (UHC) by the Kenyans. SHIF came with a bucketload of promises from broader coverage, including outpatient services, emergency treatment, to coverage of chronic illnesses, which were often neglected under NHIF.
Additionally, the government promised that the SHIF model would address the problem of “anti-selection,” where individuals only contribute when they anticipate needing medical services. By enforcing a continuous contribution model, SHIF was expected to stabilize health insurance funding, ensuring better long-term service delivery.
Barely weeks after its commencement, there are already growing concerns that the transition from NHIF to SHIF may simply represent a cosmetic change. The phrase “same monkeys, different trees” encapsulates the concern that while the name and structure of the scheme are changing, the same operational issues and employees from NHIF will carry over, likely perpetuating inefficiencies and corruption
Under SHIF, services such as emergency care, dental treatment, and coverage for chronic diseases are promised, but the ability to deliver these effectively depends on the capacity and integrity of the same bureaucratic framework that struggled under NHIF. Without addressing these systemic issues, the new system may fail to deliver on its promises.
Since SHIF came into effect on October 1, 2024, it has faced strong criticism from various sectors, and heavy backlash from Kenyans including a court petition seeking to block its implementation. The petition, filed by the Busia Senator, Hon. Okiya Omtatah in the company of others, argues that the subsidiary legislation required to operationalize the Social Health Insurance Act is not yet in place. They claim this makes the SHIF’s implementation unconstitutional and are asking the court to nullify the subsidiary legislation, which they believe is being misused to push the rollout forward.
In conclusion, the transition from NHIF to SHIF marks a significant step forward in Kenya's healthcare system, aligning with the nation's aspirations for universal health coverage. However, concerns persist about the potential for SHIF to replicate the inefficiencies, corruption, and mismanagement that plagued NHIF, with an additional pinch of it biting further into mwananchi’s humble pie – with high percentage deductions having been proposed through the fund. Without fundamental reforms in administration and oversight, the switch will not yield tangible improvements. While SHIF offers the promise of enhanced healthcare access and services, its ultimate success will hinge on the Kenyan government's ability to genuinely transform the systemic rot rather than merely rebranding it.
Categories: SHIF Universal Healthcare Coverage Healthcare Accessible Affordable healthcare NHIF
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