Despite the substantial contributions required under the new Social Health Insurance Fund (SHIF), many Kenyans are expressing concerns that the promised benefits may not live up to expectations.

As Kenya gears up for the official launch of SHIF on 1st October 2024, which will replace the National Hospital Insurance Fund (NHIF), questions about the value of the new scheme's offerings are mounting.

Under SHIF, Kenyans will contribute 2.75 per cent of their income towards health insurance.

For salaried employees, this will be a monthly deduction, while those in the informal sector will make annual payments.

Just to bring this into perspective, a worker earning Sh20,000 per month will now contribute Sh6,600 annually, while someone earning Sh100,000 will pay Sh2,700 monthly, up from the current Sh1,700.

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High-income earners will face significantly larger deductions, with those earning Sh500,000 per month contributing Sh13,750 monthly, or Sh165,000 annually.

Corporate executives earning Sh10 million per month will be required to pay Sh275,000 each month, totalling Sh3.3 million per year.

However, many are concerned that the benefits do not match these hefty contributions.

SHIF members will receive a primary healthcare package capped at Sh900 per year, covering consultations, lab tests, and prescriptions—benefits viewed as minimal given the increase in contributions.

Families will also receive limited optical care at Sh1,000 annually and dental coverage at Sh2,000 per year, though the dental package will only be available after a budgetary allocation.

The limitations extend to other critical healthcare services. While cancer screening rates are in place, specific screenings will not be immediately available.

Patients managing chronic conditions such as diabetes and kidney disease will have minimal coverage.

The SHIF will only cover a single HbA1c test for blood sugar monitoring at Sh1,000 per year, and a creatinine test for kidney function at Sh300 annually.

Cholesterol tests for patients at risk of cardiovascular diseases will also be capped at Sh300 once a year.

Inpatient services have seen a reduction in coverage compared to earlier proposals.

Hospital admissions at levels 4, 5, and 6 hospitals will now receive payments between Sh3,360 and Sh4,480 per day, lower than the Sh5,000 daily cap initially suggested.

Families will be restricted to a maximum of 180 days of hospitalisation per year, with a total inpatient coverage limit of just over Sh806,000, regardless of contributions.

For those requiring overseas medical treatment, SHIF will provide a limit of Sh500,000 per year, but only if the treatment is sought through healthcare providers listed by the Social Health Authority (SHA) abroad.

As the SHIF programme prepares for its launch, there is growing dissatisfaction among Kenyans, who feel that the benefits fall short of the substantial contributions being demanded.

Many are now questioning whether the new scheme can deliver on its promises of universal health coverage and equitable healthcare access for all citizens.