Mental Health Support Through SHA

Introduction

The Social Health Authority (SHA), established under the Social Health Insurance Act of 2023, is a transformative step in Kenya’s pursuit of 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. Mental health support, a historically underfunded area in Kenya, is integrated across all three funds, offering preventive, outpatient, and inpatient services at Levels 1-6 facilities. As of September 2025, with over 20 million Kenyans enrolled, SHA has significantly expanded mental health coverage, addressing the needs of an estimated 4 million Kenyans with mental health disorders, including 1 million with severe conditions like depression and schizophrenia. This article details SHA’s mental health services, eligibility, funding, access, challenges, and impact, drawing on official regulations and recent data.

Background and Evolution from NHIF

Mental health care under NHIF was severely limited, covering only basic inpatient psychiatric care and minimal outpatient counseling, often with caps (e.g., KSh 1,000/visit) and restricted to select facilities like Mathari National Hospital. This left 75% of Kenyans with mental health needs reliant on out-of-pocket payments, exacerbating financial hardship and stigma. Kenya’s mental health burden is significant: WHO estimates a 1:400 psychiatrist-to-patient ratio and a 1:1,000 psychologist ratio, with 40% of primary care patients presenting mental health symptoms.

SHA’s mental health support, launched in 2024, integrates services across PHCF (preventive/community-based), SHIF (outpatient/specialized), and ECCF (inpatient/critical), aligning with the Mental Health Policy 2021-2025 and Article 43 of the Constitution, which guarantees healthcare access. By 2025, SHA has empaneled over 500 facilities for mental health services and trained 100,000+ Community Health Promoters (CHPs) to provide psychosocial support, marking a significant leap toward destigmatization and accessibility.

Funding Mechanism

Mental health services are funded through SHA’s tripartite structure:

• PHCF: Fully government-funded (KSh 10 billion in 2024/25 via national budgets, county contributions, and grants), covering free community-based screenings and counseling at Levels 1-3 (community units, dispensaries, health centers).
• SHIF: Contribution-based (2.75% of gross income for salaried; minimum KSh 300/month for informal sector), funding outpatient specialist care and medications at Levels 4-6 (county/referral hospitals). Indigent populations are subsidized via programs like Inua Jamii.
• ECCF: Government-funded through appropriations and donations, covering inpatient psychiatric care and critical interventions (e.g., severe psychosis), with no additional contributions required.

SHA disburses funds to over 10,000 accredited facilities via digital claims on the Afya Yangu platform, processed within 30 days, improving on NHIF’s 90+ day delays. Audits ensure transparency, addressing past fraud concerns.

Eligibility and Access

All SHA-registered residents qualify for mental health services:

• Eligible Groups: Kenyan citizens, non-citizens residing over 12 months (e.g., expatriates, refugees), and their dependents (unlimited spouses/children).
• 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. Referrals from CHPs or Level 1-3 facilities to Level 4-6 hospitals are digital, ensuring seamless care.

Mental Health Services Covered

SHA’s mental health support spans preventive, outpatient, and inpatient care, tailored to address Kenya’s high burden of depression (1.9 million cases), anxiety, substance abuse, and severe disorders.

PHCF Mental Health Services (Levels 1-3)

Free at community units, dispensaries, and health centers, focusing on prevention and early intervention:

• Screenings: Assessments for depression, anxiety, PTSD, and substance abuse via CHPs and primary care providers.
• Psychosocial Support: Basic counseling for stress, grief, and perinatal depression, delivered by over 100,000 CHPs under Afya Bora Mashinani.
• Health Education: Community programs to reduce stigma and promote mental wellness, including suicide prevention workshops.
• Referrals: CHPs link patients to Level 4-6 facilities for advanced care, using digital tools for coordination.

SHIF Mental Health Services (Levels 4-6)

Covers specialized outpatient care at county and referral hospitals:

• Specialist Consultations: Unlimited visits to psychiatrists, psychologists, and counselors.
• Therapies: Cognitive Behavioral Therapy (CBT), group therapy, and trauma-focused interventions.
• Medications: Antidepressants, antipsychotics, anxiolytics, and mood stabilizers, fully covered for diagnosed conditions.
• Substance Abuse Programs: Outpatient detoxification and counseling for alcohol and drug dependency.
• Perinatal Mental Health: Screening and treatment for postpartum depression and anxiety.

ECCF Mental Health Services (Levels 4-6)

Covers inpatient and critical care for severe conditions:

• Inpatient Psychiatric Care: Hospitalization for acute psychosis, schizophrenia, bipolar disorder, and suicide risk, including ward stays and intensive monitoring.
• Electroconvulsive Therapy (ECT): For treatment-resistant depression or severe mania, with SHA pre-approval.
• Crisis Intervention: Emergency care for acute mental health crises, including 24/7 psychiatric support at referral hospitals.
• Rehabilitation: Long-term inpatient programs for severe substance abuse or chronic mental disorders.

Comparison with NHIF

Facilities and Infrastructure

SHA accredits over 500 facilities for mental health services:

• Level 1-3 Facilities: 8,000+ community units, dispensaries, and health centers for screenings and counseling.
• Level 4-6 Facilities: 2,000+ county and referral hospitals (e.g., Mathari, Kenyatta National Hospital, Moi Teaching and Referral Hospital) for specialized and inpatient care.
• Digital Tools: Afya Yangu app and *147# USSD enable facility searches, tele-counseling, and appointment scheduling. Claims are processed within 30 days.
• CHPs: Over 100,000 promoters trained in mental health first aid, using tablets for data entry and referrals.

The Benefits and Tariffs Advisory Panel, chaired by Prof. Walter Jaoko since May 2025, adjusts coverage and tariffs to ensure quality.

Limitations and Exclusions

SHA’s mental health support has constraints:

• Specialized Treatments: Experimental therapies (e.g., certain neuromodulation techniques) are excluded unless approved by SHA.
• Non-Accredited Facilities: Services at non-empaneled providers are not covered; patients must verify facilities on sha.go.ke.
• Contribution Dependency: SHIF outpatient services require active contributions; non-payment may delay non-emergency care, though PHCF and ECCF services remain accessible.
• Provider Shortages: Only 100 psychiatrists and 500 psychologists serve Kenya’s 54 million population, limiting specialized care access.

Impact and Benefits

SHA’s mental health services have delivered significant outcomes:

• Financial Protection: Reduced out-of-pocket costs by 30% for mental health care, shielding families from expenses averaging KSh 20,000/month for severe cases.
• Increased Access: Mental health consultations rose by 25% in 2025, with 70% of users from low-income groups, compared to NHIF’s 5% poor coverage.
• Health Outcomes: Early intervention increased by 20% for depression and 15% for substance abuse, reducing hospitalizations. Suicide prevention programs reached 1 million via CHPs.
• Equity: Subsidies and free PHCF services ensure access for informal sector workers (30% enrollment vs. NHIF’s 20%). GeoPoll’s 2025 survey shows 55% of Kenyans view SHA’s mental health support positively.

Challenges and Solutions

Challenges include:

• Provider Shortages: Limited specialists; SHA is training 1,000 CHPs annually in mental health and partnering with universities to increase psychiatrists.
• Stigma: Cultural barriers reduce uptake; SHA’s community campaigns aim to destigmatize mental health.
• Reimbursement Delays: Some facilities report 60-day lags; SHA targets 30-day payments via digital claims.
• Awareness Gaps: 35% of rural residents unaware of SHA’s mental health scope; radio and CHP outreach are intensifying.

Future Outlook

SHA plans to enhance mental health services by:

• Expanding CHP training to 150,000 by 2027 for broader psychosocial support.
• Increasing PHCF funding to KSh 15 billion by 2026/27 to bolster community care.
• Integrating tele-psychiatry via Afya Yangu for rural access.
• Adding dedicated mental health counselors at Level 4 facilities by 2026.

Conclusion

SHA’s mental health support marks a paradigm shift in Kenya’s healthcare system, offering comprehensive services from community-based screenings to inpatient psychiatric care. By integrating mental health across PHCF, SHIF, and ECCF, SHA addresses NHIF’s gaps, reducing financial barriers and stigma. Despite challenges like provider shortages and awareness gaps, digital tools and CHP outreach enhance access and equity. For registered Kenyans, SHA’s mental health services provide a vital lifeline, fostering a healthier, more inclusive society by 2030.

HUBA MAISHA MAGIC BONGO 17TH SEPTEMBER 2025 WEDNESDAY LEO USIKU SEASON 14 EPISODE 80