The good, bad and ugly about Social Health Authority (SHA): Part One

Touted as major health sector reform initiative towards the realisation of the Universal Health Coverage (UHC) in the country, the controversial Social Health Authority (SHA) came to force on October 1, 2024 effectively replacing the defunct National Hospital Insurance Fund (NHIF).

Being a special purpose vehicle that houses the Primary Health Care Fund (PHCF), Social Health Insurance Fund (SHIF) and the Emergency, Chronic and Critical Illness Fund (ECCIF), SHA is a key ingredient to Kenya’s UHC policy 2020-2030 and has since attracted praise and condemnation in equal measure.

Although at inception SHA was aimed at eliminating challenges dogging the health sector notably inequitable access to care, high out-of-pocket expenditures, fragmented and inefficient health financing mechanisms, its false start has proved access to affordable, accessible and quality healthcare services to all Kenyans a nightmare owing to rampant system glitches that has threatened effective and efficient rollout of the program.

Under the UHC agenda where SHA is a critical component, in June 2023, The Informer Media Group can authoritatively reveal that the Ministry of Health sought approval from the National Treasury for Specially Permitted Procurement Procedure (SPPP) to engage in a contract with “strategic partners” to implement the Sh104.81billion Healthcare Information Technology dubbed health technology platform to digitise healthcare services and enhance efficiency and data management.

While the health information technology platform would serve as the software, medical equipment leasing programme under National Equipment Service Project (NESP) coupled by the Community Health Promoters (CHP) kits supplies would complement as hardware components.

However, SHA has since abandoned the Sh104billion technology infrastructure system being supplied by a partner under the Safaricom PLC led consortium and opted for services of a local firm, Savannah Informatics at a much cheaper cost.

The consortium that the Ministry of Health entered into a contract with to digitise the health services at a cost of Sh104.81billion for a period of twelve years is comprised of Safaricom Limited, Apeiro Limited and Konvergenz Network Solutions Limited.

On the other hand, on September 13, 2023, the Ministry of Health entered into a contract with Surgimed Medical Supplies Company Limited, a Chinese firm to supply medical kits for Community Health Promoters (CHP) for a period of three years.

In the three-years contract, Surgimed Medical Supplies is to supply MoH with Community Health Promoters (CHP) kits, consumables and medicine supplies in phases.

According to contract, in the first year, the supplies were valued at Sh10.2billion, with Sh6.8billion projected for the second year and Sh7.6billion for the third.

In the first year, Surgimed Medical Supplies was to supply kits worth Sh3.88billion and consumables such as glucometer test strips at a cost of Sh2.97billion alongside medicine supplies worth Sh3.3billion.

In the second year, Surgimed Medical Supplies was to deliver kits at a cost of Sh3.18billion and medicine supplies at a cost of Sh3.6billion.

And in the third year in a row, Surgimed Medical Supplies, according to the contract is supposed to deliver kits at a cost of Sh3.56billion and medicine supplies at a cost of Sh3.9billion.

While appearing before the National Assembly Health Committee recently, Public Health and Professional Standards Principal Secretary Mary Muthoni said the ministry has so received 100,000 kits on September 22, 2023 alongside the medicines that were distributed to county headquarters from Harmony Vibrant International Kenya on behalf of Surgimed Medical Supplies.

On the UHC’s hardware component, the Senate Public Accounts Committee (PAC) is probing the legality of multi-billion-shilling contracts signed between counties and the national government for the lease of the new medical equipment aimed at supplying medical devices to county hospitals under the National Equipment Service Project (NESP).

While appearing before the Senate Public Accounts Committee (PAC) on December 3, 2024, Nyeri governor Mutahi Kahiga, who is the vice-chairperson of the Council of Governors (CoG) blew the lid off over the new medical equipment leasing deal terming it as shadowy.

However, president William Ruto said the deal is above board but the identity of the suppliers whom he said are seven in number and the costings alongside the procurement process remains a closely guarded secret by the Ministry of Health.

NESP is a successor to the contentious Medical Equipment Services (MES) that was implemented in the first devolved county governments.

Whereas Safaricom and Konvergenz Network Solutions Limited reportedly delivered on their part of the bargain, Apeiro is said to have only managed to provide tablets that are being used on membership registration and some funds for operations.

Safaricom was to provide infrastructure that included connectivity and servers while Konvergenz Network developed payment systems that included the Afya Yangu portal.

The revelations come at a time the Ethics and Anti-Corruption Commission (Eacc) has launched investigations into the agreement between the Kenyan government and the two subsidiary companies used in the contractual and implementation of the country’s new health plan, SHA.

“Though I do not have all the details about Adani’s involvement in the SHA deal, our team is working on it to find out the full details. We are doing our investigations to get the truth about it and once we get the details, we shall inform you.” Eacc chairman Dr. David Oginde said on Monday during the commemoration of the International Anti-Corruption Day on Citizen TV.

A fortnight ago, former deputy president Rigathi Gachagua had claimed that the SHA digital infrastructure project had been overpriced.

Safaricom, Apeiro and Konvergenz were required to deliver a health information exchange, a system that was to allow health facilities to share patient records.

The consortium was to develop and rollout standard based Integrated Hospital Management Information (IHMS) system I in partnership with the Ministry of Health and county governments.

The consortium was also to deliver a technology to digitize the supply chain of health products that ensured visibility of both pharmaceutical and non-pharmaceutical products across the country. This is to enable traceability of medicine to patients.

The consortium would then support training of public health officials on the system, project management and be involved in the on-ground rollout of various technologies.