NAIROBI, Kenya- The Social Health Authority has defended its Means Testing Instrument (MTI) used to determine contributions under the Social Health Insurance Fund (SHIF), following concerns raised by Africa Uncensored.
In a detailed press statement, the Authority said the tool is grounded in equity and designed to correct historical injustices under the now-defunct National Health Insurance Fund, which it described as regressive and unsustainable.
“The transition to SHA was necessitated by structural and equitable failures of the NHIF,” the Authority said, noting that the previous model disproportionately burdened low-income earners while relying heavily on formal sector workers to finance healthcare.
Under the new framework established by the Social Health Insurance Act, 2023, contributions are pegged at 2.75 P.c of household income, subject to a minimum of Sh300 per month. The Authority said this model ensures proportional contributions based on ability to pay.
To assess households in the informal sector, SHA uses Proxy Means Testing (PMT), a system widely applied globally to identify vulnerable populations and allocate subsidies.
The Authority cited examples from countries such as Colombia and Indonesia, as well as traditional means testing systems in the United States and the United Kingdom.
SHA said the MTI was developed through a consultative process led by the Ministry of Health, involving universities, research institutions, and development partners. It relies on nationally representative data and is designed to minimise both exclusion and inclusion errors.
According to the Authority, current operational data shows that most households fall within lower contribution bands. It reported that 92 P.c of informal sector households are assessed at Sh850 or less monthly, with 45 P.c paying between Sh300 and Sh500, and 47 P.c between Sh501 and Sh850.
Only 7.1 P.c fall within the Sh1,001–3,499 band, while 0.4 P.c are assessed above Sh3,500, indicating that the system largely shields low-income households from high contributions.
The Authority also emphasised safeguards for vulnerable groups, stating that indigent households are identified through integration with data from the State Department for Social Protection and are fully subsidised by the government.
To address income irregularities in the informal sector, SHA highlighted its “Lipa SHA Pole Pole” initiative, which allows members to pay contributions flexibly through daily, weekly, or monthly instalments.
Responding to criticism over accuracy, SHA acknowledged that no predictive model is perfect but said mechanisms are in place to correct errors.
It pointed to an internal appeals system that allows members to contest their assigned contributions, with plans to streamline the process through faster reviews and expanded access via digital and assisted platforms.
The Authority also announced plans to incorporate Alternative Dispute Resolution (ADR) mechanisms to handle disputes more efficiently.
SHA said it remains committed to refining the system through improved data partnerships with county governments, the Kenya National Bureau of Statistics, and other state agencies, while maintaining engagement with civil society and the media.
As implementation continues, the Authority said it will prioritise transparency and responsiveness to ensure the system delivers on its goal of universal, equitable health coverage.
