MP Tables Motion to Cap SHA Contributions at Ksh 500, Proposes Seven Other Reforms

Mumias East Member of Parliament (MP) Peter Salasya has tabled a motion to amend parts of the Social Health Authority (SHA).

Salasya has suggested a number of changes to solve the operational, financial and structural problems that the scheme is facing at the moment.

He argues that the proposed Bill, “seeks to amend the Social Health Insurance Act, 2023 to provide for critical operational, financial and structural problems being faced by the Social Health Authority.”

Problems include persistent delays in addressing the claims from public hospitals, misunderstanding regarding the structure of SHA funds and non-compliance on the part of contributors.

The latter stated that, “persistent delays and inability to pay claims from public health facilities” has made it difficult to deliver services, while “the non-compliance by members in paying their premiums” remains a challenge to the fund’s survival.

Proposed Shift to Flat Monthly Contribution

At the core of the proposed reforms is the introduction of a flat-rate contribution model.

Bill seeks to amend Sections 26 and 27 of the Act to replace income-based annual premiums with a standard monthly payment.

“Every contributor shall pay a standard monthly contribution of Kenya Shillings Five Hundred (Ksh 500) to the Social Health Insurance Fund,” the proposal states.

This would mark a return to a simplified contribution structure similar to the defunct NHIF model, aimed at improving affordability and compliance.

Additionally, the MP proposes that contributions to SHIF be payable on a monthly basis with the Authority required to provide, “flexible payment mechanisms including mobile and digital platforms.”

Introduction of Voluntary Solidarity Mechanism

The Bill also introduces a new provision allowing voluntary contributions to support vulnerable populations.

According to the proposal, “a contributor may make voluntary additional contributions on behalf of another registered beneficiary or a national solidarity pool for indigent and vulnerable persons.”

With regard to the challenges that healthcare providers have encountered in connection with delays, there is an introduction of time periods during which claims ought to be processed.

It is proposed that there will be a requirement that SHA shall resolve all validated claims presented to SHA by health facilities within a period of sixty days.

Any non-compliance shall result in penalties, and, “sanctions or prescribed interest may be applied.”

Also Read:SHA Explains How Children Over 18 Can Remain on Parents’ Health Cover

Improved Transparency on Coverage Benefits

Additionally, the Bill aims at clarifying any issues regarding the SHA benefits by ensuring that the full benefits package is published.

The Bill requires that the, “Authority publish and update regularly the comprehensive benefits package that outlines: services included; entitlements for each tier of service including Level 4; and exclusions and co-payments.”

This provision responds to concerns that many Kenyans are unclear about what services they are entitled to, particularly under the three existing funds.

In a move targeting maternal healthcare, the MP proposes reinstating the Linda Mama programme.

The amendment states that, “the Ministry of Health through the Authority shall provide free maternal healthcare services under a Program covering antenatal, delivery, and postnatal care.”

The proposal follows concerns that the discontinuation of the programme has forced expectant mothers to incur out-of-pocket costs, with some required to pay at least Ksh 6,000 for services.

Also Read:SHA Announces Gradual Rollout of Tariffs in Claims System

Mandatory Contribution Enforcement

In order to enhance enforcement, the Bill proposes additional provisions that will enforce mandatory contributions.

The Bill states that, “all registered members should be statutorily obligated to make their contributions.”

In addition, the Bill empowers the Authority to have inspectors to ensure that employers comply.

These provisions arise amid widespread discrepancies in the number of persons registered and those contributing to the fund.

Millions are registered, but only a few contribute regularly.

Lastly, this proposal intends to streamline the current system through merging the three funds into one entity.

“Amendments should be made to collapse the three funds into one unified fund in order to reduce any confusion and not to rely on the exchequer.”

The Bill, presented according to Standing Orders 114(1) and 117, will go through legislative drafting prior to debate at the National Assembly.

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Mumias East Member of parliament Peter Salasya in a past parliamentary service committee session. PHOTO/ PCS