In this episode recorded on 03.10.2024, we are joined by Dr. Brian Lishenga - Founding Chair of Rupha Kenya and Dr. Trizah Tracey John - Ag. Head of Health Financing at the Ministry of Health to discuss the Social Health Insurance Fund. We cover the transition from NHIF to SHIF, SHIF benefits, NHIF’s weaknesses that SHIF seeks to address, implementation challenges, funding mechanisms, and the claims process. Subscribe to get notified when we make a new post. Key Quotes “We have the four main sources, where we have the government sources, we have the health insurance aspect, and we have external funding commonly what we call the donor funding, as well as what the population pay at the site, at the point of service delivery, that is the out of pocket expenditure. So looking at those four elements, the whole principle of health financing is to try and balance those four by making sure we have more government funding, more health insurance, less out-of-pocket expenditure, and less reliance on donor funding so that we have sustainable financing for the country.” Dr. Trizah Tracy John “The other key difference is that SHA actually carries three funds whereas NHIF had just one fund, the insurance fund managing the insurance scheme. Under SHA, the authority, that is the Social Health Authority, seeks to manage three funds. And that is the primary health care fund, the Social Health Insurance Fun (SHIF), and the emergency chronic and critical illness fund.” Dr. Trizah Tracy John “The issue of fraud is double-sided in the sense that one, it was conveniently used to push back against a genuine request for payment. Number two, it was an issue that required collaboration by rogue providers and some NHIF staff.” Dr. Brian Lishenga “One of the things that is obviously clear and the reason for the vigorous debate is that the money available to pay for the benefits is not enough. Even if we tax at 2.75%, we don't think we will raise enough money to pay for the healthcare that Kenyans want.” Dr. Brian Lishenga “As a country, we need a blueprint for health. We can't have the cyclic political changes that we see in the health sector, because on average, it takes about 15 years for you to realize any return on investment in any change that you bring into the sector, and we must quarantine the sector from the political happenings. And a blueprint is the only way that can change this, and we will use how much of acreage, maybe a president, a governor or your MP is able to cover in that blueprint as the indicators for success.” Dr. Tim Theuri Show Notes 00:00:00 Introduction 00:02:07 Transition from NHIF to SHIF 00:09:25 Healthcare Provider’s Perspective 00:16:49 Fraud Within NHIF 00:20:40 NHIF’s Weaknesses that SHIF Seeks to Address 00:30:32 Implementation Challenges and Patient Experiences 00:37:58 SHIF Benefits 00:45:09 Funding, Claims, and Informal Sector Contributions 00:50:05 Proxy Means Testing 00:52:17 Balancing Benefits and Financial Realities 01:03:12 Concluding Remarks Get full access to The Mwango Weekly at mwangocapital.substack.com/subscribe
