NHIF against SHA

The introduction of the Strategic Health Audit (SHA) in Kenya is usually aimed at improving the efficiency, effectiveness and quality of health services. That may well be. Before SHA, there was the NHIF. That was stalled. The National Hospital Insurance Fund (NHIF) was a government-owned enterprise in Kenya established to provide health insurance to all Kenyan citizens. It is an important part of the Kenyan health system and aims to make health services accessible and affordable to all citizens, especially those with low incomes. NHIF was designed to provide health insurance coverage for inpatient and outpatient services. At the same time, it was designed to reduce the financial burden of health costs on individuals and families. NHIF covers a wide range of medical services including hospitalization, obstetrics, surgery, dialysis, cancer treatment and chronic disease management. It also covers outpatient services such as doctor consultations and laboratory tests under certain packages. Who is covered by NHIF? All employees are required by law to contribute to NHIF. Self-employed persons and those in the informal sector can join and contribute voluntarily. The government provides subsidized NHIF insurance for vulnerable groups such as the elderly, orphans and people with disabilities. Contributions are based on income, with formal workers contributing a percentage of their salary. Members of the informal sector pay a fixed monthly fee that varies depending on the package chosen. The NHIF has introduced enhanced benefit packages to cover different income groups, including comprehensive coverage for chronic diseases and specialty care. The Supreme Cover is a premium package that offers enhanced benefits, including coverage for outpatient services and higher coverage amounts for inpatient treatment. NHIF has struggled with problems such as late payments to hospitals, fraud and inefficiencies in service delivery. NHIF plays a crucial role in Kenya's Universal Health Coverage (UHC) agenda, ensuring that all citizens have access to quality healthcare without facing financial hardship. It is particularly beneficial for low-income households as it provides a safety net against high medical costs. Now SHA would be introduced.  SHA helps identify gaps and areas where health care can be improved. By systematically reviewing health services, the audit can highlight deficiencies and recommend corrective actions to improve the quality of patient care. Healthcare resources are often limited, especially in developing countries like Kenya. SHA can help in the optimal allocation and use of these resources by identifying areas where they are most needed and ensuring they are used efficiently. SHA promotes accountability and transparency in the health system. Through regular reviews of health services, it ensures that health care providers and administrators are held accountable for their performance and that there is transparency in the management and use of resources. The data and insights from SHA can support policy and decision-making. It provides evidence-based information that can guide the formulation of health policies, strategies and interventions to improve the overall health system. SHA serves as a tool for continuous monitoring and evaluation of health services. It helps track progress toward health goals and objectives, evaluate the impact of health interventions and make necessary adjustments to health programs. By identifying risks and areas where patient safety may be at risk, SHA helps implement measures to prevent medical errors, reduce hospital-acquired infections and improve overall patient safety. SHA ensures that health facilities and providers adhere to national and international health standards and guidelines. This is critical for maintaining high standards of care and for accreditation purposes. Conducting SHA can also serve as a capacity building exercise for health workers. It involves training and skills development that can improve the competencies of health professionals in providing quality care. SHA involves various stakeholders including health care providers, administrators, policy makers and sometimes patients. This involvement promotes a collaborative approach to improving health services and ensures that the perspectives of all stakeholders are considered. SHA is part of a continuous improvement process. It promotes a culture of continuous evaluation and improvement within the health system, leading to sustainable improvements in health care. In summary, the implementation of SHA in Kenya aims to improve the overall performance of the health system and ensure that it delivers high quality, efficient and equitable health services to the population. This all sounds wonderful. There are just a few comments to be made here as well. While the Strategic Health Audit (SHA) in Kenya is designed to improve health care, its implementation may face several challenges. These issues may compromise the effectiveness of the SHA and limit its potential benefits. Conducting a comprehensive SHA requires significant resources, including financial, human and technical resources. Kenya, like many other developing countries, may face limitations in these areas, making it difficult to conduct thorough and regular audits.  All patients who were registered in NHIF must re-register in SHA, which is not easy. There are several hurdles to overcome.  An effective SHA requires trained and qualified personnel who can accurately collect, analyze and interpret data. In Kenya, there may be a shortage of such professionals, leading to gaps in the audit process and potentially unreliable results. The accuracy and reliability of the SHA depend on the quality of the data collected. In Kenya, there may be problems with the completeness, accuracy and timeliness of the data. Poor data quality can compromise the effectiveness of the audit and lead to incorrect conclusions and recommendations. Implementing changes based on SHA findings can be challenging, especially if there is resistance from health care providers, administration or other stakeholders. This resistance may be due to a lack of understanding, fear of accountability, or reluctance to change established practices. The health infrastructure may be inadequate to support implementation of SHA recommendations. For example, it may lack the necessary medical equipment, facilities, or information systems needed to improve health care. The health system, as in many other countries, may be influenced by political and bureaucratic factors. These may affect the prioritization and implementation of SHA recommendations and lead to delays or overlooking critical issues. Effective SHA requires the involvement of multiple stakeholders, including healthcare providers, patients, and policy makers. Limited engagement or collaboration from these groups can lead to a lack of ownership and commitment to the audit process and its outcomes.  Ensuring the sustainability of improvements identified through SHA can be challenging. Maintaining momentum for continuous quality improvement can be difficult, particularly when competing priorities or resource constraints exist. The cultural and contextual factors can influence the acceptance and implementation of SHA. For example, traditional beliefs and practices may conflict with recommended changes, making it difficult to achieve desired outcomes. Continuous monitoring and evaluation are critical to the success of SHA. However, there may be gaps in these processes, resulting in non-follow-up on recommendations and inability to track progress over time. Addressing these challenges requires a multifaceted approach that includes capacity building, resource allocation, stakeholder engagement, and the development of robust data systems. By overcoming these obstacles, SHA can increase its effectiveness and achieve significant improvements in its health system. The introduction of SHA may have been a good idea, but it turns out that SHA does not work! Private hospitals in Kenya no longer treat SHA patients. This is because SHA does not pay on time. Perhaps it has something to do with the fact that all government payments are now made into a single pot and no one really knows who paid what, where, when, or how much.  In any case, I can hardly see any difference between NHIF and SHA. The tasks are the same!  According to President Ruto, who said before the introduction of SHA that all people in Kenya should be insured, including tourists who come to this country. From my own experience, I can say, ha, I pay for insurance, but I am not insured.