Experts Call for Inclusive, Transparent Health Financing as SHIF Faces Challenges
Kenya’s transition from the National Health Insurance Fund (NHIF) to the Social Health Insurance Fund (SHIF) has triggered a spirited public discourse, with experts, providers, and community representatives voicing deep concerns over equity, sustainability, and public trust.
Speaking during a high-level health financing forum in Nairobi, legal and health policy experts emphasized that while SHIF aims to address NHIF’s past failures, it may be replicating the same structural weaknesses particularly the inability to mobilize funds from the informal sector, which forms over 80% of the workforce.
“Kenya’s informal sector isn’t necessarily poor, but many evade structured contributions,” noted one panelist, stressing that income-based contributions are necessary for equity.
“The principle of ‘ability to pay’ ensures fairness, but enforcement remains elusive.”
Alternatives Overlooked critics questioned why the government didn’t explore more innovative funding models, such as earmarked taxes for health akin to the fuel levy for roads.
“We have precedents like Ghana’s VAT model. Even without cars, Kenyans still use matatus and boda bodas. A health levy on fuel would have expanded the tax base significantly without burdening the poorest households,” said another contributor.
Trust and Transparency Deficits Private health providers acknowledged the goodwill they’ve shown in the past by offering services despite delayed payments, but warned that without trust and accountability, public buy-in will remain elusive.
“When people queue in hospitals and fail to access essential care like dialysis, they naturally question the value of their contributions,” said Dr. Joanne Osorogwe, representing the Kenya Association of Private Hospitals.
She emphasized the need for timely payments and open reconciliations to build trust.Digital Hurdles and Community Disconnect concerns were also raised about SHIF’s registration process, which relies heavily on digital platforms. Community health workers reported that many vulnerable Kenyans lack access to the necessary tools or literacy to register, especially in informal settlements.
“Most residents can’t navigate the online system or afford a cyber café. We need community-based education and outreach to bridge this gap,” said Juliana Kimura, a community health worker from Makadara.
Social Accountability and Mental Health university students and civil society groups called for stronger social accountability mechanisms, including public audits, civil society oversight, and open access to fund disbursement data.
They also highlighted the mental toll on healthcare workers in underfunded and overstretched facilities, urging the government to invest in provider well-being and quality of care.
while SHIF was billed as the long-awaited solution to NHIF’s inefficiencies, experts say a successful transition requires more than structural change. It demands transparency, inclusive financing models, public engagement, and decisive action against corruption.
“We must fix the deeper issues honesty, equity, and accountability if we want a truly universal and sustainable healthcare system,” said one speaker.
