Gov’t Launches New SHA Financing Model To Combat Fraud
The Ministry of Health has implemented a new Primary Health Care (PHC) finance model in which payments to health institutions will be based on the actual number of patients served rather than insurance coverage.
This ensures that funds are allocated where they are most needed.
In a statement issued on Wednesday, March 5, the ministry highlighted the transition as a significant step toward Universal Health Coverage (UHC).
This new payment mechanism differs from the National Health Insurance Fund (NHIF) model, which determines payments to health facilities based on the patient’s insurance status.
New Healthcare Financing Model Ensures Fairness & Accountability pic.twitter.com/PkO6wHpf4d
— Ministry of Health (@MOH_Kenya) March 5, 2025
This means that only insured people who paid their payments in advance received services.
Individuals pay insurance premiums to fund healthcare services.
The former model frequently excluded people who couldn’t afford insurance premiums, creating financial barriers to healthcare access.
“This new approach will not only ensure that healthcare funds reach the right places but will also strengthen service delivery by prioritising patient needs over insurance status,” the ministry stated.
The new model ensures that all patients receive care, with facilities reimbursed using verifiable service data.
To ensure timely reimbursements, the government lowered claims processing period from 90 days to 30 days.
Furthermore, all PHC payments would be routed directly to PHC-funded accounts, ensuring dedicated funding for important healthcare services.
The Social Health Authority (SHA) is streamlining claims processing to ensure timely reimbursements, keeping healthcare facilities running smoothly. pic.twitter.com/angJlPz3n9
— Ministry of Health (@MOH_Kenya) March 6, 2025
The ministry has now advised counties to strengthen Facility Improvement Fund (FIF) committees to improve budget management and service delivery.
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Furthermore, the ministry said that all primary healthcare services will be fully tax-funded, underlining the idea that healthcare is a fundamental right rather than a privilege.
Fully tax-supported means that primary healthcare services under this model are entirely sponsored by taxes, making them more accessible, particularly to those who previously faced financial constraints.
“With primary healthcare now fully tax-funded, no Kenyan will be locked out of essential services,” Health Cabinet Secretary Deborah Barasa revealed on Wednesday.
These new adjustments come as the ministry tries to streamline the sector and improve services in the face of Kenyans’ complaints that it is failing.
Gov’t Launches New SHA Financing Model To Combat Fraud
