One of the largest health reforms in Kenya involves transitioning from the National Hospital Insurance Fund to Social Health Insurance Fund. Recent Health ministry studies indicate that effective participation of the public in this transition could increase its success rate by up to 70 per cent, yet many Kenyans are uncertain about the impending changes.
Herein lies the power of meaningful public engagement, particularly illustrated in Mombasa through their pilot programme. In 2023, community dialogues by local health officials reached over 100,000 residents, explaining the SHIF framework and listening to their responses.
This led to a 45 per cent increase in voluntary pre-registration for the new system and highlighted essential implementation issues before the national roll-out. Public participation has already underscored vital gaps in the proposed SHIF structure: in Kisumu, for example, community health forums highlighted that workers in the informal sector—80 per cent of the workforce—fear monthly contributions being taken off; as such, flexible payment plans were devised, including the use of mobile money instalment payments and seasonal payment plans for farmers.
The result of people’s participation is that, ever since the universal healthcare programme started in Makueni, it has been used continually as a model for SHIF implementation. The county attained 87 per cent coverage through regular public forums, where the community concerns were addressed and policies adjusted to suit the needs of the locals. Healthcare providers report a 60 per cent increase in visits for preventive care following community-suggested improvements to services.
Religious and community leaders have become key stakeholders in public education. In Garissa, for instance, the engagement of imams and elders raised SHIF awareness by 65 per cent in communities that had been resistant to the new scheme. Their involvement helped overcome misconceptions related to the Islamic finance elements of the new system and enhanced enrolment.
Wairimu Mwangi, Rongo University
