In a transformative move toward achieving Universal Health Coverage (UHC), the Ministry of Health has intensified efforts to implement the Social Health Insurance Fund (SHIF) under the Taifa Care model. This initiative is aimed at ensuring equitable and sustainable healthcare financing, offering all Kenyans access to essential health services without financial hardship.
The Taifa Care model, a core pillar of the Kenya Kwanza government’s UHC agenda, seeks to address historical inequities in the healthcare system by introducing an income-based contribution model. Under this system, contributions are determined through proxy means testing to assess financial capacity, setting the minimum contribution for vulnerable households at KES 300 — a significant reduction from the KES 500 charged under the previous National Health Insurance Fund (NHIF). Households with higher incomes are expected to contribute proportionally more, ensuring fairness and equity in the system.
The Ministry of Health emphasized that the average monthly premium per person should be at least KES 880 for SHIF to remain financially sustainable, though the current average stands at KES 1,065. This balance ensures that the fund remains both affordable and viable while maintaining adequate resources to cover healthcare benefits for all members.
A key feature of the Taifa Care model is its shift from the inefficiencies of the NHIF structure, which struggled with inequitable contributions, reimbursement delays, and financial instability. By adopting a structured and transparent payment system, SHIF enhances efficiency in fund management, guarantees timely payments to healthcare providers, and safeguards the quality and availability of healthcare services.
In response to concerns raised by the Rural Private Hospitals Association (RUPHA) regarding SHIF reimbursement structures, the Ministry of Health reaffirmed its commitment to fostering collaborative engagement with private healthcare providers. Recognizing the importance of an inclusive healthcare system that integrates public and private facilities, the Ministry has introduced clear guidelines for facility accreditation, standardized claims submission processes, and a digital system for real-time claim tracking.
“These measures are designed to eliminate past inefficiencies and ensure that all service providers receive their payments on time,” the Ministry stated.
As the government continues to refine the Taifa Care model, it remains dedicated to ensuring accessible, affordable, and high-quality healthcare for every Kenyan. This bold step toward UHC reflects the government’s commitment to transforming the nation’s healthcare landscape and addressing long-standing challenges in the sector.
