Eight months into implementation of the Social Health Insurance Fund, popularly known as Shif, opinion remains divided on whether the new system is providing better access to healthcare for citizens who have all along been uninsured.
On Tuesday, there were heated exchanges on the floor of the Senate about the progress and status of the implementation of the programme and whether it was working well.
Supporters of the programme, the likes of the Senate Majority Leader, Aaron Cheruyoit, argued that the best way to test the impact of the new system should be through testimonials from patients.
He said he had personally visited four sub-county hospitals in his Kericho County and “had learnt from first-hand interviews and testimonials from patients whose bills have been paid under the new system, that the scheme was making a big impact.”
On the flip side, opposition to the new scheme remains loud. Anxiety about change and distrust of the incumbent political class are a major factor.
In a deeply polarised society like we live in today, your own political biases can block your sight from seeing the big picture. We may not be aware of fundamental changes and developments happening under our own noses.
When you follow the Shif debate closely, discussions bear only tangential relations to real and broad health policy issues at stake. Some of the questions we are not asking: What is the likely impact on existing employee-based private insurance? What is the likely impact and what trends are we seeing in terms of uptake from the millions of uninsured informal sector employees? In the context of high drop-out rates from insurance programmes witnessed in this market, what is the likely impact of the new regime?
Does Senator Cheruyoit have a point when he argues that we should pay more attention to testimonials by users and from the ground where the rubber meets the road? But the problem with testimonials is that they neither give you the big picture nor the complexities at play.
In our circumstances, your best bet at arriving at the truth, especially when you want to measure uptake and to assess impact, is to focus on hard statistics — numbers, ratios and percentages.
Health economists will tell you that when you want to assess uptake of a public health intervention such as Shif, you have to track enrolment numbers, look at data on utilisation and access, statistics on ease of enrolment and numbers on awareness of the programme among the public. You must monitor coverage rates and follow the statistics and data on payment of claims.
I recently accessed hard statistics on uptake and acceptability of Shif and here are the numbers. After eight months, the scheme has enrolled and registered 23 million individuals.
This compares to 14 million in the 59 years life of the now defunct National Health Insurance Fund (NHIF). Only five million were actively contributing under NHIF.
As of the beginning of this week, SHIF was registering an average of 40,000 individuals per day. The age profile data of those enrolling in the scheme is equally revealing: 34 percent are between the ages of 18 and 35; 28 percent between 36 and 55; 13.9 percent are above 55; and 24 percent are below 18. Shif is a Gen Z thing.
The number of hospitals enrolled are at 9,674 in eight months compared to 8,000 hospitals under NHIF. In terms of claims paid, the scheme has in the eight months of its existence paid Sh55 billion. The data also shows that as at Wednesday this week, 3.1 million had been treated and paid for by Shif.
What has the scheme paid for in the eight months? Sh27 billion went to inpatient- treatment, maternity and neo-natal (Sh7 billion), surgical cases (Sh5 billion), renal cases (Sh5 billion) and oncology cases (Sh4 billion).
Another important statistic is what they describe as ‘means testing’. It measures the number of individuals who are not in salaried employment but have filled in forms and provided the data to be used in assessing their incomes and in determining the monthly premiums they will pay.
By Wednesday, the number of individuals on the ‘means testing’ bracket had reached five million. Clearly, the uptake potential for the informal sector is very large.
Yet reeling out numbers, ratios and percentages will only tell you half of the story. Our ambition is how to change access to essential and cost- effective healthcare to citizens, regardless of their financial status.
Still, even the most strident critic of Shif will accept that these statistics provide irrefutable evidence that major changes are taking place in our health sector. We are learning a big lesson on uptake and acceptability of public health interventions.
The writer is a former Managing Editor for The EastAfrican.
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