SHA Highlights Expanded Medical Benefits for Civil Servants

SHA Highlights Expanded Medical Benefits for Civil Servants.

The Social Health Authority (SHA) has issued updated guidance regarding medical services for civil servants and their dependents, ensuring clarity under the revised regulations.

Robert Ingasira, the chief executive officer of SHA, outlined in communication to healthcare providers that the Public Officers Medical Scheme Fund (POMSF) is now operational under the 2024 regulations.

This framework aims to provide civil servants and their dependents with services equivalent to those offered under the previous comprehensive medical insurance scheme.

Seamless Transition for Beneficiaries

Ingasira emphasized the importance of healthcare providers keeping their staff informed about the new guidelines to guarantee a smooth transition and uninterrupted services for the scheme’s beneficiaries.

The medical fund covers a range of benefits for civil servants, including outpatient and inpatient care, annual medical checkups, as well as dental and optical services.

The scheme extends these benefits to principal holders along with up to six dependents.

Transition to SHIF: A New Era in Healthcare

The year 2024 marked a significant shift in Kenya’s healthcare system as the now-defunct National Health Insurance Fund (NHIF) was replaced by the controversial Social Health Insurance Fund (SHIF), overseen by the Social Health Authority (SHA).

The SHA has been tasked with managing SHIF, which officially came into effect on October 1, 2024.

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The new fund is projected to generate Ksh148 billion annually through member contributions, calculated using means-testing instruments for those without formal employment.

Additionally, three consortiums led by Safaricom have been commissioned to develop an Integrated Healthcare Information Technology System (IHTS) at a cost of Ksh104 billion, recoverable over a decade.

Despite these efforts, Kenyans continue to face challenges accessing healthcare under SHIF due to numerous technical issues encountered during its rollout.

Reflections on NHIF’s Legacy

As Kenyans grapple with the transition to SHIF, many look back at the benefits offered by NHIF that contributed to better healthcare access. Here are five standout programs under NHIF:

Enhanced Scheme (ES)

The Enhanced Scheme (ES) was a negotiated healthcare cover between NHIF and procuring entities.

It provided comprehensive services beyond the standard National Health Scheme (NHS) and catered to Civil Servants, National Police and Prisons Services (NPS/KPS), County Governments, Parastatals, Pension Schemes, and various public organizations. This tailored coverage offered broader healthcare access to these groups.

Linda Mama Program

Initially launched as Free Maternity Services in June 2013, the Linda Mama program transitioned to NHIF administration in 2016.

Officially rolled out in April 2017, this government flagship initiative aimed to provide all pregnant Kenyan women with access to quality maternity care, regardless of financial ability.

Funded by the Government of Kenya, World Bank, and JICA, Linda Mama offered a one-year cover from the time of activation, ensuring affordable maternal and infant health services, thereby advancing Universal Health Coverage (UHC).

Maternal and Child Health Services

Beyond Linda Mama, NHIF extended its maternal and child health services to include family planning, immunizations, and pediatric care for young children, further enhancing the accessibility of essential healthcare services.

NHIF UHC Supa Cover: A Comprehensive Package

Under the Universal Health Coverage (UHC) agenda, the NHIF Supa Cover emerged as a robust health insurance solution for both individuals and families, covering outpatient and inpatient services. Key packages included:

• Inpatient Benefits: Covered hospital stays, diagnostics, specialist consultations, and prescribed treatments.
• Outpatient Benefits: Included GP consultations, diagnostics, day-care procedures, and mental health services.
• Maternity Benefits: Provided comprehensive care for pregnancy, delivery (normal or caesarean), and postpartum services.
• Specialized Packages: Ranged from renal dialysis and oncology treatments to surgical and mental health care.
• Emergency Services: Supported ambulance services via Kenya Red Cross E-Plus.
• Overseas Treatment: Covered treatments unavailable locally, including advanced diagnostics and surgeries.

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Focus on the Vulnerable

NHIF played a crucial role in supporting the elderly, orphans, and persons with disabilities by subsidizing their healthcare needs under the UHC agenda. This focus on vulnerable groups underscored NHIF’s commitment to equitable healthcare access.

Conclusion

While SHIF aims to reform Kenya’s healthcare system, the technical challenges it faces have highlighted the need for efficient implementation. Many Kenyans still fondly recall the NHIF’s impactful programs, which laid the groundwork for advancing Universal Health Coverage in the country.

SHA Highlights Expanded Medical Benefits for Civil Servants.

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