Infectious Disease Treatment in SHA

Introduction

The Social Health Authority (SHA), established under the Social Health Insurance Act of 2023, is Kenya’s cornerstone for achieving Universal Health Coverage (UHC), replacing the National Health Insurance Fund (NHIF) as of 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 to over 26 million enrolled Kenyans as of September 22, 2025. Infectious diseases, including malaria, tuberculosis (TB), HIV/AIDS, and diarrheal diseases, remain a significant public health challenge in Kenya, contributing to 30% of deaths and 50% of hospital admissions, per the Ministry of Health (MoH) 2023 data. SHA’s comprehensive approach to infectious disease treatment integrates prevention, diagnosis, treatment, and emergency care, reducing out-of-pocket costs (previously 26% of health expenditures under NHIF) by 40% and improving health outcomes. By July 2025, SHA facilitated 4.5 million primary care visits, including screenings for infectious diseases, and 2.2 million specialized services. This article provides a detailed overview of infectious disease treatment under SHA, covering mechanisms, benefits, facilities, challenges, success stories, and future plans, based on official regulations and data as of September 22, 2025, 10:52 AM EAT.

Background: Infectious Disease Burden and NHIF Limitations

Kenya faces a high burden of infectious diseases:

• Malaria: 8 million cases annually, causing 15% of hospital admissions, particularly in rural and coastal regions.
• Tuberculosis (TB): 120,000 cases yearly, with 20% co-infected with HIV, per MoH 2023.
• HIV/AIDS: 1.4 million people living with HIV (PLHIV), with 22,000 new infections and 18,000 AIDS-related deaths in 2022, per UNAIDS.
• Diarrheal Diseases: Account for 9% of under-5 deaths, linked to poor sanitation in informal settlements.
• Emerging Threats: Outbreaks like cholera (5,000 cases in 2022) and antimicrobial resistance (AMR) strain resources.
• Economic Impact: Treatment costs pushed 1.5 million into poverty annually under NHIF, with out-of-pocket expenses dominating.

NHIF’s limitations exacerbated these challenges:

• Limited Coverage: Only 26% of Kenyans were enrolled by 2023, with 20% informal sector uptake. Coverage capped at KSh 400,000/year for inpatient care, excluding most outpatient treatments.
• Access Barriers: Rural areas lacked diagnostic facilities, while urban hospitals like Kenyatta National Hospital (KNH) faced 1–2 week wait times.
• Prevention Gaps: NHIF offered minimal support for screenings, vaccinations, or health education, leading to late diagnoses.

SHA addresses these through progressive contributions (2.75% of income, minimum KSh 300/month), subsidies for 1.5 million indigent households (announced by President William Ruto on September 13, 2025), and a robust infectious disease program. By July 2025, SHA disbursed KSh 551 billion to over 10,000 facilities, enhancing treatment access.

Infectious Disease Treatment Under SHA Funds

SHA’s infectious disease treatment spans its three funds, integrating prevention, diagnosis, treatment, and emergency care.

1. Primary Health Care Fund (PHCF)

• Funding: Fully government-funded with KSh 10 billion in 2024/25, covering free services at 8,000+ Level 1-3 facilities (community units, dispensaries, health centers).
• Infectious Disease Services:
• Screenings: Free tests for malaria, TB, HIV, and waterborne diseases (e.g., cholera, typhoid).
• Vaccinations: 95% coverage for under-5s (e.g., measles, BCG) and adults (e.g., yellow fever in endemic areas).
• Prevention: Free insecticide-treated nets (ITNs) for malaria, condoms and pre-exposure prophylaxis (PrEP) for HIV, and water purification for diarrheal diseases.
• Health Education: Over 100,000 Community Health Promoters (CHPs) educate on hygiene, sanitation, and disease prevention.
• Delivery: CHPs conduct door-to-door screenings and distribute ITNs, reaching 70% of households by September 2025.
• Impact: 4.5 million primary care visits by July 2025, with malaria and TB screenings reducing late diagnoses by 15%, per MoH data.

2. Social Health Insurance Fund (SHIF)

• Funding: Contribution-based (2.75% of income, KSh 300/month minimum), with subsidies for low-income households.
• Infectious Disease Services:
• Outpatient Care: Consultations (KSh 1,000–2,000), diagnostics (e.g., malaria rapid tests KSh 500, TB sputum tests KSh 1,000), and medications (e.g., artemisinin-based combination therapy for malaria, KSh 500–2,000).
• Inpatient Care: Hospital stays (KSh 2,240/day at Level 3) for severe malaria, TB, or HIV-related infections.
• HIV/AIDS Treatment: Free or subsidized antiretroviral therapy (ART, KSh 2,000–5,000/month market cost) for 1.4 million PLHIV, with viral load/CD4 testing (KSh 3,000–10,000).
• TB Treatment: Free anti-TB drugs (KSh 5,000–10,000 for 6-month course) and follow-up care.
• Delivery: Provided at Level 4-6 facilities (county/referral hospitals), with 180 renal units and 53 cancer centers addressing HIV/TB complications.
• Impact: 2.2 million specialized services by July 2025, with 90% of PLHIV on ART, up from 70% under NHIF.

3. Emergency, Chronic, and Critical Illness Fund (ECCF)

• Funding: Government-funded with KSh 5 billion in 2024/25, covering catastrophic care.
• Infectious Disease Services:
• Emergencies: Free ambulance services (KSh 5,000–10,000/trip) and ICU care (KSh 28,000/day) for severe cases (e.g., cerebral malaria, multidrug-resistant TB).
• Critical Care: KSh 700,000 for kidney transplants for HIV-related renal failure, KSh 500,000 for overseas treatment (e.g., advanced HIV therapies).
• Palliative Care: Free for 800,000 terminal patients with end-stage AIDS or TB complications.
• Delivery: Provided at Level 2-6 facilities, with pre-approval for high-cost treatments via Afya Yangu.
• Impact: Reduced infectious disease mortality by 10%, with 10 endoscopy procedures for HIV complications at KUTRRH by October 2024.

4. Subsidies and Inua Jamii Integration

• Means-Testing: Households below KSh 3,252/month pay KSh 300/month or receive waivers, with 1.5 million indigent subsidized by September 2025.
• Inua Jamii: Vulnerable groups (e.g., orphans, elderly) receive KSh 2,000/month cash transfers, with 90,000 enrolled in SHA by August 2025 for free infectious disease care.
• Impact: 70% of beneficiaries are low-income, ensuring access for rural and slum residents.

5. Digital Management via Afya Yangu

• Functions: Registration, facility searches, claims submission, and benefit tracking via sha.go.ke or *147# USSD.
• Infectious Disease Application: Patients locate testing/treatment facilities (e.g., KNH for TB), verify ART coverage, and track claims. CHPs assist non-digital users.
• Impact: 80% of claims processed electronically by mid-2025, streamlining access for 4.5 million primary care visits.

Key Facilities for Infectious Disease Treatment

SHA accredits over 10,000 facilities, with key public and private hospitals providing infectious disease care:

• Kenyatta National Hospital (KNH), Nairobi: Level 6, offers ART, TB treatment, and ICU care, receiving KSh 70 million in SHA funds in August 2025.
• KUTRRH, Nairobi: Treated 61 chemotherapy patients with HIV-related cancers by October 2024.
• Moi Teaching and Referral Hospital (MTRH), Eldoret: Provides ART and TB co-infection care.
• Coast General Teaching and Referral Hospital, Mombasa: Offers malaria and HIV treatment for coastal regions.
• Rural Dispensaries: Over 6,000 Level 1-3 facilities provide free testing and preventive measures.

Benefits of SHA’s Infectious Disease Treatment

• Prevention: Screenings and ITNs reduced malaria incidence by 15%; 95% of pregnant women received HIV testing for PMTCT.
• Treatment Access: 90% of PLHIV on ART, with 2.2 million specialized services by July 2025.
• Cost Reduction: Out-of-pocket costs dropped by 40%, saving KSh 5,000–50,000 per patient annually.
• Equity: 70% of beneficiaries are low-income, with 1.5 million indigent covered.
• Health Outcomes: Reduced infectious disease mortality by 10%, per MoH 2025.

Success Stories

1. Kibera, Nairobi: A low-income woman used Afya Yangu to access free PHCF malaria testing in 2025, receiving SHIF-funded treatment (KSh 2,000) at Mbagathi Hospital, saving KSh 5,000, per a Ministry briefing.
2. Turkana County: A CHP screened a child for TB in 2025, referring them for free SHIF-funded treatment at Lodwar County Hospital, as shared during President Ruto’s September 13, 2025, meeting.
3. KUTRRH, Nairobi: An HIV-positive patient with TB accessed ECCF-funded ICU care (KSh 28,000/day) in 2024, per KUTRRH’s October report.

Challenges

• Reimbursement Delays: KSh 43 billion in unpaid dues by August 2025 disrupt services, with RUPHA’s September 2025 go-slow threat.
• Provider Shortages: Only 500 surgeons and 200 specialists serve 54 million, limiting complex care.
• Awareness Gaps: 35% of rural residents unaware of SHA benefits, per GeoPoll 2025.
• Digital Barriers: ASAL regions lack internet for Afya Yangu, though *147# helps.
• Fraud Risks: KSh 20 million ghost claims in 2025 prompted stricter audits.

Reforms and Solutions

• Payment Reforms: KSh 551 billion disbursed by July 2025, targeting KSh 43 billion arrears clearance by 2026.
• Provider Training: SHA plans to train 500 specialists by 2027.
• Awareness Campaigns: CHP-led outreach targets 80% coverage by 2026.
• Digital Fixes: September 2025 Afya Yangu upgrades resolved eClaims bugs.
• Anti-Fraud: Biometric verification cut fraud by 15% in 2025.

Future Outlook

SHA aims to:

• Increase PHCF funding to KSh 15 billion and ECCF to KSh 8 billion by 2026/27, expanding testing and treatment facilities.
• Deploy AI diagnostics via Afya Yangu for infectious disease monitoring by 2027.
• Subsidize 1.5 million more indigent by 2026.
• Expand TB and HIV treatment centers to 200 by 2027.

Conclusion

SHA’s infectious disease treatment, integrating PHCF prevention, SHIF treatments, and ECCF interventions, has transformed care for 26 million Kenyans, with 4.5 million primary care visits and 90% ART coverage. Success stories from Kibera, Turkana, and KUTRRH highlight reduced costs and improved outcomes. Challenges like arrears and digital barriers persist, but reforms signal progress. Patients should use Afya Yangu, *147#, or CHPs to access benefits, advancing Kenya’s UHC vision by 2030.

KINA MAISHA MAGIC EAST MONDAY 22ND SEPTEMBER 2025 SEASON 5 EPISODE 100

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