Duale: New SHA healthcare model offers broader, fairer access than NHIF

Health Cabinet Secretary Aden Duale has defended the new Social Health Authority, saying it is a more inclusive and effective system than the defunct National Hospital Insurance Fund.

Speaking in the Senate, Duale said SHA introduces a wider approach to healthcare delivery, solving many problems that had persisted under NHIF. He highlighted the creation of three new dedicated funds that were not available before: the Primary Healthcare Fund, the Social Health Insurance Fund and the Emergency, Chronic and Critical Illness Fund.

“These funds ensure a full spectrum of care,” Duale said, “covering preventive, promotive, curative, rehabilitative and palliative services.”

He said SHA removes the need to pay regular monthly contributions to access basic care, unlike NHIF, which only served those who consistently paid premiums.

“With SHA, primary healthcare becomes accessible to all. Registration alone grants access, unlike NHIF, which excludes non-paying members,” he said.

Patients are no longer required to pick one hospital for outpatient care. Under SHA, they can go to any contracted facility for services including health education, diagnosis, treatment, lab tests, radiology and chronic disease care.

“SHA offers a much broader and more flexible outpatient package, making it more effective, especially for chronic disease management,” Duale said.

He said SHA is designed to handle up to 70 percent of the country’s disease burden, with better access to care and wider service options.

Duale said eye care has also been expanded.

“SHA provides a comprehensive optical care package, including eye health education, eye examinations, basic medication and surgical procedures.” NHIF, he added, had no preventive focus and limited coverage.

On inpatient services, Duale said SHA offers up to 180 days of hospital stay per household and covers more types of care, including HDU and palliative care.

It also pays for preadmission screening, accommodation, specialist services and follow-up after discharge. In contrast, NHIF offered a fixed daily amount depending on hospital level, with fewer hospital options.

Maternity care has also been expanded under SHA. “Reimbursement for normal delivery has increased from Sh5,000 to Sh10,000, while Caesarean delivery is now covered up to Sh30,000,” Duale said.

He added that the Linda Mama programme had been improved to offer more antenatal, postnatal, critical care and newborn immunisation.

NHIF, he said, often left mothers with out-of-pocket payments in case of complications and lacked neonatal immunisation cover.

Renal care has also improved. SHA covers three dialysis sessions per week, more advanced kidney treatments and transplant care.

“SHA renal care includes management of chronic or acute kidney failure,” Duale said. NHIF only covered two dialysis sessions, and extra treatment required co-payment.

Duale said SHA is also addressing mental health. It offers education, counselling, psychosocial support and in-patient rehabilitation for substance use. NHIF offered limited services, often with extra costs and only in select centres.

On cancer care, Duale said SHA follows the National Cancer Control Programme, offering chemotherapy, radiotherapy, surgery and tests. “Under NHIF, oncology was limited to specific amounts and sessions, with mandatory co-payments,” he said. “SHA makes cancer treatment more predictable and accessible.”

Surgery services have also expanded. SHA covers the full process—before, during and after surgery. NHIF only offered set surgery packages depending on hospital level, with many patients required to co-pay.

For dental care, SHA pays for consultations, preventive care and restorative services such as scaling, extractions and treatment for infections. NHIF, Duale said, only covered tooth extractions.