The Primary Health Care Fund Explained

Introduction

The Primary Health Care Fund (PHCF) is a cornerstone of Kenya’s Social Health Authority (SHA), established under the Social Health Insurance Act of 2023 to advance Universal Health Coverage (UHC). Launched on October 1, 2024, as part of SHA’s tripartite funding structure—alongside the Social Health Insurance Fund (SHIF) and the Emergency, Chronic, and Critical Illness Fund (ECCF)—the PHCF focuses on delivering free preventive, promotive, and basic curative services at community and primary healthcare levels (Levels 1-3). Unlike SHIF, which requires individual contributions, PHCF is fully government-funded, ensuring no out-of-pocket costs for all registered Kenyans and long-term residents. As of September 2025, the PHCF has significantly reduced financial barriers, with over 20 million enrolled in SHA, enhancing access to grassroots healthcare. This article explores the PHCF’s purpose, funding, services, implementation, and impact, drawing on official sources and recent data.

Purpose and Objectives

The PHCF is designed to strengthen Kenya’s primary healthcare system, aligning with the Primary Health Care Act, 2023, and the constitutional mandate (Article 43) for accessible healthcare without financial hardship. Its primary objectives include:

• Preventive and Promotive Care: Reduce disease burden through early detection, vaccinations, and health education.
• Equitable Access: Ensure free services at community units, dispensaries, and health centers (Levels 1-3) for all residents, particularly rural and low-income populations.
• Referral Linkages: Connect communities to higher-level care (via SHIF/ECCF) through a structured referral system led by Community Health Promoters (CHPs).
• Cost Reduction: Minimize hospital admissions by addressing health issues early, with studies estimating preventive care can cut healthcare costs by up to 40%.

By prioritizing grassroots care, PHCF addresses the historical underfunding of primary healthcare, which received only 20% of Kenya’s health budget pre-2023 despite handling 70% of healthcare needs.

Funding Mechanism

Unlike SHIF, which relies on mandatory contributions (2.75% of income), PHCF is entirely funded by the government, ensuring no financial burden on individuals. Funding sources include:

• National Budget Allocations: Annual parliamentary appropriations, with KSh 10 billion allocated for PHCF in the 2024/25 fiscal year.
• County Government Contributions: Counties supplement PHCF for local facilities, covering operational costs like CHP stipends.
• Grants and Donations: External partners (e.g., WHO, Global Fund) provide additional funding for specific programs like vaccinations.
• Tax Revenues: General taxation, including health-specific levies, supports the fund.

These funds are managed by SHA, with disbursements to accredited primary care facilities (public, private, and faith-based) based on patient volume and service delivery reports. Transparency is enforced through SHA’s digital claims system and annual audits, addressing past NHIF mismanagement issues.

Covered Services

PHCF provides a comprehensive package of free services at Levels 1-3 facilities, focusing on prevention and early intervention. Key services include:

• Preventive Care:
• Vaccinations (e.g., measles, polio, HPV).
• Screenings for non-communicable diseases (e.g., hypertension, diabetes, cervical/breast cancer).
• Malaria prevention (bed nets, spraying in endemic areas).
• Promotive Care:
• Health education on nutrition, hygiene, and lifestyle.
• Community outreach via CHPs under the Afya Bora Mashinani initiative.
• Basic Curative Care:
• Treatment for common ailments (e.g., respiratory infections, diarrhea).
• Minor procedures and wound care.
• Maternal and Child Health:
• Antenatal and postnatal care.
• Child wellness (growth monitoring, immunizations).
• Family planning services (contraceptives, counseling).
• Mental Health:
• Basic counseling and psychosocial support.
• Referrals for advanced mental health needs via SHIF.
• Community-Based Interventions:
• Home visits by over 100,000 CHPs for health assessments and referrals.
• Management of chronic conditions (e.g., HIV, TB) at community level.

Services are accessible at approximately 8,000 Level 1-3 facilities, including community units, dispensaries, and health centers, listed on sha.go.ke. No co-payments or fees apply, unlike NHIF’s limited outpatient coverage (capped at KSh 1,000/visit).

Eligibility and Access

All SHA-registered residents—Kenyan citizens and non-citizens residing over 12 months—are eligible for PHCF benefits without contributions. Key access features:

• No Cost: Services are free at point of care, removing financial barriers.
• Registration Requirement: Must be enrolled in SHA via national ID, passport, or alternative documents (e.g., birth certificate for minors). Former NHIF members auto-transitioned but require biometric re-verification.
• Dependents: Unlimited spouses and children covered under principal’s registration.
• No Waiting Period: Immediate access post-registration, unlike NHIF’s 60-day wait for new members.
• Referral System: CHPs link patients to facilities; referrals to Level 4-6 hospitals (covered by SHIF/ECCF) are coordinated digitally.

Implementation and Infrastructure

The PHCF operates through:

• Accredited Facilities: Over 8,000 Level 1-3 facilities (public, private, faith-based) empaneled by SHA, meeting standards for staffing, equipment, and hygiene. Accreditation lists are public on sha.go.ke.
• Community Health Promoters (CHPs): Over 100,000 CHPs conduct household visits, screenings, and referrals, equipped with tablets for real-time data entry into the Afya Yangu platform.
• Digital Integration: Afya Yangu app and *147# USSD enable patients to locate facilities, track records, and schedule visits. Claims are processed digitally to reduce delays.
• County Collaboration: Counties manage Level 1-3 facilities, with SHA disbursing funds based on service reports. The Facility Improvement Financing Act, 2023, supports infrastructure upgrades.

Impact and Benefits

The PHCF has transformed primary healthcare access:

• Cost Reduction: Eliminated out-of-pocket costs for primary care, previously 26% of health expenditures, protecting 1.5 million from medical poverty annually.
• Increased Utilization: 2025 data shows a 35% rise in primary care visits, particularly in rural areas, due to free services and CHP outreach.
• Health Outcomes: Early detection of diseases (e.g., 20% increase in cancer screenings) and higher vaccination rates (95% coverage for under-5s) reduce hospital admissions.
• Equity: Benefits rural and indigent populations most, with 70% of PHCF users from low-income groups, compared to NHIF’s 5% coverage for the poor.
• Community Empowerment: CHPs enhance health literacy, with 80% of surveyed households reporting better awareness of preventive care.

Challenges and Solutions

Despite successes, PHCF faces hurdles:

• Facility Gaps: Rural areas lack sufficient Level 2-3 facilities; SHA is scaling up mobile clinics and CHP coverage.
• Payment Delays: Some facilities report delayed reimbursements; SHA’s digital claims system and 2025 budget increases aim to resolve this.
• Awareness: GeoPoll’s 2025 survey notes 30% of rural residents unaware of free PHCF services; radio and CHP campaigns are intensifying.
• Quality Concerns: Some facilities lack adequate staff or equipment; the Facility Improvement Financing Act supports upgrades.

Future Outlook

The PHCF is pivotal to achieving UHC by 2030. Planned enhancements include:

• Expanding CHP coverage to 150,000 by 2027.
• Increasing budget allocations to KSh 15 billion by 2026/27.
• Integrating AI-driven diagnostics at Level 2-3 facilities via Afya Yangu.
• Strengthening mental health services with dedicated counselors at health centers.

Conclusion

The Primary Health Care Fund is a game-changer in Kenya’s healthcare landscape, offering free, accessible services at the community level. By focusing on prevention, equity, and digital integration, PHCF reduces financial burdens and improves health outcomes, particularly for underserved populations. While challenges like rural access and facility readiness persist, ongoing reforms and government commitment position PHCF as a model for sustainable UHC. For Kenyans, registering with SHA unlocks this vital resource, paving the way for a healthier nation.

KINA MAISHA MAGIC EAST TUESDAY 16TH SEPTEMBER 2025 SEASON 5 EPISODE 97