Health CS Aden Duale has defended the controversial new healthcare programme as a more effective system for Kenyans compared to the now-defunct National Hospital Insurance Fund.
Speaking before the Senate plenary, Duale outlined how the Social Health Authority introduces a broader approach to healthcare delivery, addressing past limitations of the NHIF.
“SHA has introduced three dedicated funds that were not available under NHIF,” Duale said.
He cited the Primary Healthcare Fund, the Social Health Insurance Fund and the Emergency, Chronic and Critical Illness Fund.
These funds ensure a full spectrum of care, he said, covering preventive, promotive, curative, rehabilitative and palliative services.
Unlike NHIF, where access was limited to those who consistently paid monthly premiums, SHA allows all Kenyans to access primary healthcare simply by registering.
“With SHA, primary healthcare becomes accessible to all. Registration alone grants access, unlike NHIF, which excludes non-paying members,” he said.
The new model could address up to 70 per cent of the country’s health burden, Duale said.
SHA removes the requirement to pre-select a health facility. Patients can seek care at any SHA-contracted health facility.
Services include health education, diagnosis, treatment, essential lab tests, radiology and chronic disease management.
“Under NHIF, outpatient care was limited to four visits per year and tied to one selected facility,” Duale said.
“SHA offers a much broader and more flexible outpatient package, making it more effective, especially for chronic disease management.”
Duale said SHA provides a comprehensive optical care package, including eye health education, eye examinations, basic medication and surgical procedures.
NHIF, by comparison, offered limited coverage, with no focus on preventive or long-term eye health, he said.
Through SHIF, SHA delivers comprehensive in-patient care, covering different levels of facilities, with up to 180 days of hospitalisation per household.
Services now include HDU and palliative care, preadmission evaluation, hospital accommodation, specialist consultations and post-discharge follow-up.
NHIF, in contrast, provided a fixed daily rebate for hospitalisation based on hospital categories, often with limited facility options.
On maternity services, under SHA, maternity and neonatal care now includes expanded antenatal and postnatal services, critical care for mother and newborn and immunisations for newborns.
The CS said SHA has enhanced the Linda Mama programme introduced by the former regime to help mothers seeking maternity services.
Reimbursement for normal delivery has increased from Sh5,000 to Sh10,000, while Caesarean delivery is now covered up to Sh30,000.
NHIF previously covered maternity only partially, often with co-payments in the event of complications, and did not include neonatal immunisation, he said.
On renal care, Duale said SHA covers three sessions of haemodialysis per week, hemodiafiltration and peritoneal dialysis and pre- and post-kidney transplant care.
“SHA renal care includes management of chronic or acute kidney failure,” the CS said.
Under NHIF, only two dialysis sessions were covered per week. Patients needing more were required to co-pay, and transplant packages had strict limits.
SHA is also covering mental health services. These include education, counselling, psychosocial support and in-patient rehab for substance use disorders.
NHIF offered limited mental health support, often requiring a co-payment and only available at select facilities.
The CS said cancer treatment under SHA follows the National Cancer Control Programme (NCCP) guidelines.
These include chemotherapy, radiotherapy, surgery and routine lab investigations.
“Under NHIF, oncology was limited to specific amounts and sessions, with mandatory co-payments,” Duale said. “SHA makes cancer treatment more predictable and accessible.”
In addition, SHA covers the full scope of surgery: preoperative, intraoperative and postoperative care.
NHIF only offered set packages for surgeries, varying by hospital level, and many still required co-payments.
For dental care, SHA covers consultations, preventive care and restorative treatments like extractions, scaling and infection management. NHIF’s dental cover was limited to tooth extractions only.
