Vision and Eye Care Services Under SHA

Introduction

Vision and eye care are critical components of comprehensive healthcare, yet in Kenya, an estimated 1.2 million people live with visual impairment, including 250,000 who are blind, according to the Kenya Society for the Blind (2022). Non-communicable diseases (NCDs) like diabetes, which affects 9% of adults, and age-related conditions such as cataracts contribute significantly to this burden (KDHS 2022). The Social Health Authority (SHA), launched on October 1, 2024, under the Social Health Insurance Act of 2023, replaces the National Health Insurance Fund (NHIF) to advance Universal Health Coverage (UHC) by 2030, ensuring all 53 million Kenyans access quality care without financial hardship. As of September 2025, SHA has registered 26.7 million members, treated 4.5 million without out-of-pocket costs, and expanded specialized services, including eye care. This article provides a comprehensive, factual guide to SHA’s vision and eye care services, covering eligibility, benefits, access, challenges, and practical tips, grounded in Kenya’s medical situation, government reports, GeoPoll surveys, and public sentiment on X.

The Burden of Eye Health in Kenya

Eye health challenges in Kenya are significant:

• Prevalence: Approximately 2.2% of Kenyans are visually impaired, with cataracts (42%), glaucoma (8%), and diabetic retinopathy (7%) as leading causes (Ministry of Health, 2023).
• Access Gaps: Pre-SHA, only 17% of Kenyans had NHIF coverage, with 40% of health spending out-of-pocket, limiting access to eye care, especially in rural areas (25% uninsured, KDHS 2022).
• Economic Impact: Vision loss costs Kenya KSh 15 billion annually in productivity losses, per the International Agency for the Prevention of Blindness (IAPB, 2022).
• Risk Factors: Rising NCDs (e.g., 24% hypertension, 9% diabetes) and aging populations increase demand for eye care services.

SHA’s mandatory registration and tiered financing aim to address these gaps, integrating eye care into its three funds: the Primary Health Care Fund (PHCF), Social Health Insurance Fund (SHIF), and Emergency, Chronic, and Critical Illness Fund (ECCIF).

SHA’s Framework for Vision and Eye Care

SHA consolidates healthcare financing to deliver equitable services:

• PHCF: Funds free screenings and basic eye care at levels 1–4 (community units, dispensaries, health centers), supported by taxes and donors.
• SHIF: Covers outpatient and inpatient eye care, including surgeries, at levels 4–6 (county and referral hospitals), funded by member contributions.
• ECCIF: Supports high-cost treatments for chronic eye conditions like glaucoma and diabetic retinopathy, fully funded for registered members.

With 26.7 million enrolled and 8,813 facilities contracted (56% of 17,755) by September 2025, SHA leverages digital tools (e.g., *147# USSD, Practice 360 app) and 107,000 Community Health Promoters (CHPs) to enhance access, particularly for eye care.

Specific Vision and Eye Care Services Under SHA

1. Preventive and Screening Services (PHCF)

SHA prioritizes early detection to curb preventable blindness:

• Community Screenings: CHPs conduct door-to-door vision assessments using 100,000 health kits, identifying cataracts, refractive errors, and glaucoma. Over 1 million screenings completed since October 2024.
• Free Basic Eye Care: Level 1–4 facilities offer vision tests, basic treatments (e.g., conjunctivitis), and referrals. KDHS 2022 notes 30% of rural children lack access to such services.
• Health Education: Campaigns target NCD-related eye risks (e.g., diabetic retinopathy), with 95% awareness per GeoPoll’s February 2025 survey (n=961).

2. Outpatient and Inpatient Eye Care (SHIF)

SHIF covers a range of eye care services:

• Outpatient Services: Consultations, refraction tests, and corrective lenses at contracted facilities. Covers up to KSh 5,000 for glasses annually.
• Inpatient Services: Surgeries like cataract removal (KSh 30,000–50,000) and corneal transplants at level 4–6 hospitals, with daily coverage up to KSh 28,000 (vs. NHIF’s KSh 4,480).
• Specialist Care: Ophthalmologist visits for conditions like macular degeneration, prevalent in 5% of adults over 50 (Ministry of Health, 2023).

A 2025 Ministry report notes 1 million outpatient visits, with 10% related to eye care, benefiting 500,000 monthly users.

3. High-Cost and Chronic Eye Care (ECCIF)

ECCIF addresses severe eye conditions:

• Glaucoma Management: Covers medications, laser treatments, and surgeries (KSh 100,000–200,000/year), critical for 8% of vision loss cases.
• Diabetic Retinopathy: Funds laser therapy and anti-VEGF injections (up to KSh 550,000/year), addressing 7% of diabetic patients.
• Retinal Disorders: Supports treatments for macular degeneration and retinal detachment.
• Emergency Eye Care: Covers trauma-related surgeries, mandated regardless of contribution status per court rulings.

By September 2025, ECCIF has supported 50,000 eye-related treatments, with X posts praising “#SHAWorks for glaucoma care” but noting rural access delays.

4. Digital and Financial Innovations

• Biometric Verification: Ensures fraud-free access, rejecting KSh 10.7 billion in false claims.
• Direct Payments: SHA disbursed KSh 8 billion to facilities, ensuring timely eye care reimbursements.
• Subsidies: 1.5 million indigent households access free eye care, with 3.3 million means-tested for subsidies.

Impact on Eye Health

SHA’s interventions have made strides:

• Increased Access: 4.5 million treatments without out-of-pocket costs, with 10% addressing eye conditions.
• Screening Scale: Over 1 million vision screenings, detecting 15% more cataracts early (Ministry of Health, 2025).
• Equity Gains: 35% female registrants prioritize eye care for children and elderly dependents, per GeoPoll.
• Financial Protection: ECCIF’s KSh 550,000 coverage for chronic eye conditions reduces impoverishment, previously affecting 1 million annually.

A 2025 Cytonn Investments review estimates SHA could cut vision-related costs by 40% if scaled, but only 13% of GeoPoll respondents expect service improvements.

Challenges in Delivering Eye Care

SHA faces hurdles in eye care delivery:

• Funding Deficits: Monthly claims (KSh 9.7 billion) outstrip collections (KSh 6 billion), with only 900,000 of 16.7 million informal workers contributing, threatening ECCIF sustainability.
• Facility Gaps: Only 56% of facilities (8,813) are contracted, with rural areas (e.g., Turkana, 40%) underserved. Specialized eye clinics are concentrated in urban centers (Nairobi, Mombasa).
• Specialist Shortages: Kenya has only 200 ophthalmologists (1:265,000 patients), per the College of Ophthalmology of Eastern, Central, and Southern Africa (2023).
• Awareness Gaps: GeoPoll notes 22% misconceive SHA as “free,” and only 34% understand eye care benefits, especially in rural areas (45% of sample).
• Public Trust: X sentiment (70% negative) cites NHIF scandals and a KSh 104.8 billion project ownership controversy, with users like @Dr_AustinOmondi highlighting delays.

Practical Guidance for Accessing Eye Care

For Kenyans seeking vision services:

1. Register with SHA: Use *147#, www.sha.go.ke, or CHPs; include dependents for family coverage.
2. Undergo Means-Testing: Apply for subsidies if low-income via *147# or CHPs.
3. Seek Screenings: Visit level 1–4 facilities or CHPs for free vision tests; prioritize early detection for cataracts and glaucoma.
4. Verify Facilities: Check SHA’s website for contracted hospitals with eye care services, especially for surgeries.
5. Ensure Contributions: Pay KSh 300–1,375/month via M-Pesa (Paybill 222111) to access SHIF/ECCIF.
6. Report Issues: Contact SHA’s toll-free line (0800-720-531) or X (@SHACareKe).

Future Outlook for Eye Care

SHA targets 80% coverage by 2028, requiring 10 million informal sector contributors to close the KSh 4 billion funding gap. Planned initiatives include:

• Infrastructure Expansion: A KSh 194 billion UAE loan to equip level 4–5 facilities with eye care units.
• Workforce Development: Training 500 ophthalmic assistants by 2027 to address specialist shortages.
• Digital Scaling: Full e-GPS rollout by FY2025/26 for real-time facility tracking.
• Enhanced Benefits: Potential inclusion of subsidized contact lenses by 2026.

WHO projects that scaling primary eye care could prevent 50% of vision loss by 2030. Kenya’s CHU4UHC platform aims to digitize eye care records, improving follow-up for NCD-related conditions.

Conclusion

SHA’s vision and eye care services—spanning free screenings, outpatient care, and high-cost treatments—offer a lifeline to Kenya’s 1.2 million visually impaired, reducing financial burdens through 4.5 million zero-cost treatments and 1 million screenings. By integrating eye care into PHCF, SHIF, and ECCIF, SHA addresses cataracts, glaucoma, and diabetic retinopathy, critical for an aging and NCD-burdened population. Challenges like funding deficits, rural access gaps, and specialist shortages require proactive engagement—registering, verifying facilities, and leveraging CHPs. As SHA scales toward UHC 2030, its focus on equitable eye care can restore sight and livelihoods, ensuring no Kenyan is left in the dark.

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