Health experts blame gov't over SHA failure, say rollout was rushed

As the tussle of wills between the Ministry of Health and service providers in the country rages on, health economists have blamed the challenges that bedevil the health sector on the government’s decision to rush the rollout.

Health experts say key components, such as a proper means-testing instrument and premium financing mechanisms, were not put in place before implementation, resulting in the current mess.

The experts warn that unless the government rethinks its strategy on the Social Health Authority (SHA) rollout, healthcare access will remain an elusive dream.

Dr Mutakha Kangu, a health advisor to the Council of Governors, says the government mismanaged the transition and rushed the rollout before putting in place important transitional frameworks.

"We rushed with the rolling out before we came up with a proper proxy means-testing instrument before we also came up with the premium financing system, which the law provides for. And so people who cannot afford, they are assessed to pay, but they don't have money, so they can't be registered," said Dr Kangu.

Despite more than 19 million SHA registrations, only 3 million Kenyans in formal employment are currently making contributions to the fund.

Experts have called out the government for what they term as doublespeak, by claiming that SHA would cushion Kenyans from out-of-pocket expenditures and failing to finance the primary healthcare fund.

Clinical officers, who mainly run these primary care networks, are currently on strike, protesting exclusion from SHA. They have also taken issue with the failure to operationalize the emergency and critical care fund, exposing Kenyans to catastrophic medical expenses.

"When they leave us out and we are the ones manning these facilities, Kenyans are left to suffer," KUCCO Chairman Peterson Wachira said. 

"We also started rolling out before we even identified the indigents for whom the government is supposed to pay the premiums. The laws promised that the reforms are trying to reduce the out-of-pocket expenditure by citizens. The end result is that now many are being forced to pay out of their pocket, and we may need to pause and reflect and ask ourselves, could we have gone wrong somewhere, and what do we need to do to change?" Dr. Kangu noted.

A key campaign promise for Kenya Kwanza, the government promised a social health insurance framework that would shield Kenyans from out-of-pocket payments.

But five months after the rollout, there’s still no framework for means testing, leading to low collections of SHA monthly contributions.

As a result, the government is unable to raise enough money to finance the scheme, falling out with service providers who have withdrawn their services.

"Because of our failure to manage the transition well… health is suffering, people are suffering," Kangu added.

Access, quality, and affordability are key pillars of universal health coverage. The prevailing crisis in the health sector, ranging from strikes by clinical officers to the threat of strikes from other cadres, exposes systemic failures in the SHA rollout, making the realization of UHC in Kenya an elusive dream.