# Prosthetics and Assistive Devices Funded by SHA ## Introduction The Social Health Authority (SHA), established under the Social Health Insurance Act of 2023, is Kenya’s transformative framework for achieving Universal Health Coverage (UHC), replacing the National Health Insurance Fund (NHIF). Fully operational since October 1, 2024, SHA manages three funds—Primary Health Care Fund (PHCF), Social Health Insurance Fund (SHIF), and Emergency, Chronic, and Critical Illness Fund (ECCF)—to provide equitable healthcare access. Prosthetics and assistive devices, essential for enhancing mobility, independence, and quality of life for persons with disabilities, are primarily funded under SHIF, with additional support from ECCF for high-cost or critical cases. As of September 2025, with over 20 million Kenyans enrolled, SHA has significantly expanded access to these devices, addressing NHIF’s limited coverage, which left many patients facing out-of-pocket costs averaging 26% of health expenditures. This article details SHA’s coverage for prosthetics and assistive devices, including services, eligibility, funding, access, limitations, and impact, based on official regulations and recent data. ## Background and Evolution from NHIF Under NHIF, coverage for prosthetics and assistive devices was minimal, limited to basic wheelchairs and crutches for a small subset of members, often capped at KSh 10,000–20,000 per device. Specialized prosthetics (e.g., limb prostheses) and advanced devices (e.g., hearing aids, powered wheelchairs) were largely excluded, forcing patients to pay out-of-pocket costs ranging from KSh 50,000 for basic prosthetics to KSh 500,000 for advanced ones. With only 26% of Kenyans enrolled in NHIF by 2023 and informal sector uptake at 20%, access was severely restricted, particularly for the estimated 2.5 million Kenyans with disabilities (5% of the population, per WHO). SHA’s framework, launched in October 2024, integrates prosthetics and assistive devices into SHIF and ECCF, aligning with the Persons with Disabilities Act, 2003, and Article 43 of the Constitution, which guarantees healthcare access. By mid-2025, SHA has partnered with organizations like the Kenya Society for the Physically Handicapped (KSPH) and accredited over 500 facilities for device provision, leveraging Community Health Promoters (CHPs) for assessments and referrals. This expansion addresses Kenya’s high disability burden from conditions like road traffic accidents (3,000 deaths annually), diabetes-related amputations, and congenital impairments. ## Funding Mechanism Prosthetics and assistive devices are funded through SHA’s tripartite structure: – **SHIF**: Contribution-based (2.75% of gross income for salaried employees, deducted by employers; minimum KSh 300/month or KSh 3,600/year for informal sector via means-testing), covering standard prosthetics and assistive devices at Levels 4-6 (county and referral hospitals). Indigent populations are fully subsidized via programs like Inua Jamii. – **ECCF**: Fully government-funded through appropriations (KSh 5 billion in 2024/25) and donations, covering high-cost or critical devices (e.g., advanced prosthetics, cochlear implants) after SHIF limits are exhausted. – **PHCF**: While primarily for preventive care, it supports initial assessments and referrals for disability needs at Levels 1-3 (community units, dispensaries, health centers), free of charge. SHA disburses funds to accredited facilities and suppliers via digital claims on the Afya Yangu platform, processed within 30 days, improving on NHIF’s 90+ day delays. Audits ensure transparency, addressing past mismanagement concerns. ## Eligibility and Access All SHA-registered residents qualify for prosthetics and assistive devices: – **Eligible Groups**: Kenyan citizens, non-citizens residing over 12 months (e.g., expatriates, refugees), and their dependents (unlimited spouses and children). Patients with disabilities from trauma, chronic diseases, or congenital conditions are prioritized. – **Registration**: Mandatory and free via *147#, sha.go.ke, or Huduma Centres using national ID, passport, or alternative documents (e.g., birth certificates for minors). Former NHIF members auto-transitioned by October 2024 but require biometric re-verification. – **Access Requirements**: Present SHA membership number (via Afya Yangu app, *147#, or SMS) at accredited facilities. No waiting periods apply, unlike NHIF’s 60-day delay. Assessments by specialists (e.g., orthopedists, audiologists) determine device needs, with digital referrals from CHPs or Level 1-3 facilities. – **Contribution Dependency**: SHIF devices require active contributions; non-payment may delay non-emergency provision, though ECCF covers critical cases without additional costs. PHCF assessments are free. ## Prosthetics and Assistive Devices Covered SHA’s coverage for prosthetics and assistive devices is comprehensive, addressing mobility, sensory, and functional impairments. The Benefits and Tariffs Advisory Panel, chaired by Prof. Walter Jaoko since May 2025, defines and updates the package. ### SHIF Coverage (Levels 4-6) Covers standard prosthetics and assistive devices at county and referral hospitals: – **Prosthetics**: – Upper and lower limb prostheses (e.g., for amputations due to diabetes or trauma), up to KSh 100,000 per device, including fitting and maintenance. – Orthotic braces for spinal or limb deformities (e.g., scoliosis, polio). – **Mobility Aids**: – Manual wheelchairs (KSh 10,000–20,000, fully covered). – Crutches, canes, and walkers for post-surgical or chronic mobility issues. – Rollators for elderly patients or those with neurological conditions. – **Sensory Aids**: – Hearing aids for hearing loss (up to KSh 50,000 per ear, including batteries and maintenance). – Corrective glasses for vision impairments (post-surgical or chronic). – **Rehabilitation Support**: – Physiotherapy and occupational therapy to train patients in device use. – Custom fittings and adjustments by prosthetists or orthotists. – **Diagnostics**: Assessments (e.g., gait analysis, audiology tests) to determine device suitability. ### ECCF Coverage (Levels 4-6) Covers high-cost or critical devices after SHIF exhaustion: – **Advanced Prosthetics**: – Bionic or myoelectric limbs (up to KSh 300,000, subject to approval), for complex cases like multiple amputations. – Custom orthotics for severe deformities (e.g., post-trauma reconstruction). – **Specialized Devices**: – Powered wheelchairs for quadriplegia or severe neuromuscular conditions (up to KSh 150,000). – Cochlear implants for profound hearing loss (KSh 500,000, with SHA pre-approval). – **Overseas Provision**: Up to KSh 500,000 for devices unavailable locally (e.g., advanced prosthetics), requiring SHA pre-approval within 72 hours. ### PHCF Support (Levels 1-3) While PHCF does not fund devices, it provides free assessments and screenings for disabilities at community units, dispensaries, and health centers, with over 100,000 CHPs facilitating referrals to SHIF/ECCF for device provision. ## Comparison with NHIF | Aspect | NHIF | SHA (SHIF/ECCF) | |——–|——|—————–| | **Coverage Scope** | Basic wheelchairs, crutches; capped at KSh 10,000–20,000. | Comprehensive prosthetics, advanced devices; up to KSh 300,000 (ECCF). | | **Hearing Aids** | Not covered. | Up to KSh 50,000/ear (SHIF); cochlear implants (ECCF). | | **Advanced Prosthetics** | Excluded. | Bionic limbs, custom orthotics (ECCF). | | **Overseas Provision** | Not covered. | Up to KSh 500,000 with approval. | | **Waiting Period** | 60 days for new members. | Immediate access post-registration. | | **Dependents** | Per-person fees. | Unlimited, no extra cost. | ## Facilities and Infrastructure SHA accredits over 500 facilities for prosthetics and assistive devices: – **Level 4-6 Facilities**: County hospitals (e.g., Kirinyaga County Hospital), national referral hospitals (Kenyatta National Hospital, Moi Teaching and Referral Hospital), and private providers (Aga Khan University Hospital) for device fitting and rehabilitation. – **Specialized Centers**: Partnerships with KSPH, Association for the Physically Disabled of Kenya (APDK), and rehabilitation centers for custom prosthetics and training. – **Digital Tools**: Afya Yangu app and *147# USSD enable facility searches, appointment scheduling, and claims tracking. Claims are processed within 30 days. – **CHPs**: Over 100,000 promoters trained in disability assessments, using tablets for referrals and data entry. – **Oversight**: The Benefits and Tariffs Advisory Panel ensures quality and adjusts tariffs, with SHA enforcing audits to prevent fraud. SHA invested KSh 500 million in 2025 for prosthetic workshops and rehabilitation units in county hospitals. ## Limitations and Exclusions SHA’s coverage has constraints: – **Cosmetic Devices**: Excluded unless medically necessary (e.g., aesthetic prosthetics without functional benefit). – **Non-Accredited Providers**: Devices from non-empaneled suppliers are not covered; patients must verify providers on sha.go.ke. – **Overseas Cap**: Limited to KSh 500,000; advanced devices like cutting-edge bionic limbs may exceed this, requiring private funding. – **Contribution Dependency**: SHIF devices require active contributions; non-payment may delay non-emergency provision, though ECCF covers critical cases. – **Provider Shortages**: Kenya has only 200 prosthetists and orthotists, limiting rural access. ## Impact and Benefits SHA’s coverage for prosthetics and assistive devices has delivered significant outcomes: – **Financial Protection**: Reduced out-of-pocket costs by 40%, saving families KSh 50,000–500,000 per device, preventing medical poverty. – **Increased Access**: Device provision rose by 20% in 2025, with 70% of beneficiaries from low-income groups, compared to NHIF’s 5% poor coverage. – **Health Outcomes**: Improved mobility for 100,000+ patients, with 15% reduction in disability-related complications. Hearing aid access enhanced communication for 10,000+ individuals. – **Equity**: Subsidies and unlimited dependent coverage boosted informal sector enrollment to 30% (vs. NHIF’s 20%). GeoPoll’s 2025 survey shows 60% of Kenyans view SHA’s device coverage as accessible and effective. ## Challenges and Solutions Challenges include: – **Provider Shortages**: Limited specialists; SHA is training 500 prosthetists by 2027 and partnering with APDK for capacity building. – **Reimbursement Delays**: Some suppliers report 60-day lags; SHA targets 30-day payments via digital claims. – **Awareness Gaps**: 35% of rural residents unaware of SHA’s device scope; radio and CHP campaigns aim to educate. – **Device Maintenance**: Ongoing costs for repairs not fully covered; SHA is exploring maintenance subsidies for 2026. ## Future Outlook SHA plans to enhance coverage by: – Increasing ECCF funding to KSh 8 billion by 2026/27 for advanced devices. – Expanding local prosthetic manufacturing to reduce costs. – Integrating tele-rehabilitation via Afya Yangu for rural device training. – Establishing 10 new prosthetic workshops by 2026. ## Conclusion SHA’s coverage for prosthetics and assistive devices, funded through SHIF and ECCF, marks a significant advancement over NHIF’s limited provisions, offering comprehensive support for mobility and sensory impairments. From wheelchairs to bionic limbs, SHA reduces financial barriers and enhances equity, particularly for low-income and rural populations. Despite challenges like provider shortages and awareness gaps, digital tools and partnerships strengthen implementation. For registered Kenyans, SHA’s coverage provides a vital lifeline for disability support, advancing Kenya’s vision of inclusive healthcare by 2030.

GUNDUU KBC SEASON 1 EPISODE 6