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{
"id": 1521201,
"url": "https://info.mzalendo.com/api/v0.1/hansard/entries/1521201/?format=api",
"text_counter": 82,
"type": "speech",
"speaker_name": "Endebess, UDA",
"speaker_title": "Hon. (Dr) Robert Pukose",
"speaker": null,
"content": "representatives from the Social Health Authority to receive comprehensive responses to the issues raised by the Members. The Ministry of Health and the Social Health Authority rolled out the Social Health Authority healthcare services and benefits under three funds: the Primary Healthcare Fund, Social Health Insurance Fund and the Emergency, Chronic and Critical Illness Fund. These Funds were established under the Social Health Insurance Act No. 16 of 2023, which was enacted by this House a year ago. The Government is currently operationalising this Act, and access to SHA healthcare services and the benefits offered by SHA were rolled out on 1st October 2024. The Members of the National Assembly raised concerns regarding the delays and gaps in implementing the Social Health Insurance Fund. In response to these concerns, the Ministry of Health was invited on Monday, 10th February 2025, to provide responses to the issues raised as follows: 1. Concerns that claims were taking too long to be approved, as well as delays in the activation of new registrations, causing frustration among patients. In accordance with the SHIF Act on claims processing timelines, providers are supposed to submit claims within seven days of service delivery and processing by SHA within 90 days. 2. SHIF claims worth Ksh12 billion, representing 75 per cent, submitted between 1st October 2024 and 28th January 2025, have been processed and paid to the providers. The remaining 25 per cent, which comprises mainly of claims that require clinical review, are being processed, and payments will be made immediately after the process is finalised. 3. Primary healthcare capitation claims worth Ksh1.3 billion submitted between October and December 2024 have been processed and paid to the providers. In the initial rollout period, SHA encountered system readiness challenges, necessitating manual claims. Further, there were non-harmonised bank details in the system and delayed e-contracting, which are being addressed. In addition, the remaining claims awaiting the filing of service delivery returns from facilities are undergoing a reconciliation and payment process, which will be processed immediately. To address these challenges, SHA has put in place measures to fast-track claims processing and payment, including enhanced automation to facilitate payment on a monthly basis. Regarding activation of new registration, the activation of new registrations under the Social Health Authority is immediate. Once a member has registered or made payments, there is no waiting period for accessing services at SHA-contracted healthcare facilities. Once registered and paid up, SHIF members can access services under the following categories: Under the Primary Healthcare Fund (PCF), you can access services at Level 2, Level 3, and some Level 4 facilities for outpatient services at no cost once registered as a member or a dependent. The Social Health Insurance Fund (SHIF) is funded by 2.75 per cent contributions from both formal and informal populations. Once paid up, beneficiaries can receive treatment from Levels 4, 5, and 6 facilities. The Emergency, Chronic, and Critical Illness Fund (ECCF) currently caters to urgent care, including resuscitation and stabilisation within 24 hours for specific emergency services, per the gazetted benefit package. This is provided at no cost for the initial 24 hours, as the Fund is Exchequer-funded. Due to the current financial year funding limitation, the ECCF components are partially activated. These services are available in all Level 2 to 6 facilities for all Kenyans. The electronic version of the Official Hansard Report is for information purposesonly. A certified version of this Report can be obtained from the Hansard Editor."
}