Full list of SHA packages including in-patient, maternity, ICU, cancer & more

Primary Healthcare Fund (PHF): This fund is designed to provide essential health services at local facilities like dispensaries and health centers.

Notably, services accessed through this fund will be free of charge for patients, funded by government allocations and external grants, ensuring that no individual contributions are necessary.

An AI generated image of a doctor smiling while talking to a patient in a hospital An AI generated image of a doctor smiling while talking to a patient in a hospital Pulse Live Kenya

Social Health Insurance Fund (SHIF): The SHIF will cover inpatient services at higher-level healthcare facilities (Level 4 to 6) following referrals. All registered Kenyans will contribute 2.75% of their income to this fund, which encompasses comprehensive inpatient services including hospital accommodation and nursing care

Emergency, Chronic, and Critical Illness Fund: This fund is tailored for serious health conditions requiring immediate care, further enhancing the safety net for vulnerable populations.

Full list of benefit packages Kenyans will access under the SHA

Below is a comprehensive list of all the benefits Kenyans will access, however experts have raised concerns that the packages are below market rates and may be inadequate to cover Kenyans.

1. Primary Healthcare Fund

This fund is designed to provide essential health services at local facilities like dispensaries and health centers.

Outpatient Care Services

Health education, consultation, diagnosis, and treatment
Prescribed lab tests and basic radiology (X-rays, ultrasounds)
Prescription and drug dispensing
Management of acute and chronic conditions
Minor surgeries and immunization as per schedule

Tariff: Sh900 per person annually

Maternity, Newborn and Child Health Services

Antenatal care, normal delivery, caesarean sections
Postnatal care for mother and newborn
Nursing care, ward charges, diagnostic lab tests

Tariff: Normal delivery – Sh11,200; Caesarean section – Sh32,600

Screening & Management of Pre-Cancerous Lesions

Screening for cancers (breast, cervix, prostate, colon)
Cryotherapy, thermal ablation, and LEEP

Tariff:

HPV screening – Sh3,600
PSA test – Sh1,500
Stool occult blood test – Sh 400
Cryotherapy & Thermal Ablation – Sh 3,000
LEEP – Sh 2,800

Optical Health Services

Consultation and diagnosis for eye health
Provision of eyeglasses for refractive errors

Tariff: Sh 935 for consultation and eyeglasses. Limit: Sh 1,000 per household

End of Life Services

Preparation, preservation, and storage of body in mortuary

Tariff: Sh 500 per day (limit up to 5 days)

Medical Inpatient Services

Disease management, admission charges, nursing care
Laboratory tests, imaging, medication, and therapeutic support

Tariff: Sh 2,400 per day (limit up to 50 days)

Health CS Dr Deborah Barasa Health CS Dr Deborah Barasa Pulse Live Kenya

2. Social Health Insurance Fund

The SHIF will cover inpatient services at higher-level healthcare facilities (Level 4 to 6) following referrals.

Outpatient Care Services

Similar to primary health care services, including consultations, diagnosis, treatments
Screening for common health conditions

Tariff: Sh 2,000 per visit (limit of 4 visits per person annually)

Medical Inpatient Services

Similar to PHC inpatient services, including hospital accommodation, specialist reviews

Tariff:

Level 4 – Sh 3,500 per day
Level 5 – Sh 4,000 per day
Level 6 – Sh 5,000 per day

Limit: Up to 50 days per household

Maternity, Neonatal and Child Health Services

Normal deliveries, assisted deliveries, caesarean sections
Newborn care, midwifery, diagnostics, and family planning

Tariff:

Normal delivery – Sh 11,200
Caesarean Section – Sh 32,600

Renal Care Package

Dialysis management for chronic and acute kidney failure
Specialist consultations, lab tests, medication

Tariff:

Hemodialysis & Hemodiafiltration – Sh 10,650 per session
Peritoneal dialysis – Sh 180,000 per month

Limits:

3 sessions per week for haemodialysis
2 sessions per week for haemodiafiltration
12 sessions annually for peritoneal dialysis

Mental Wellness Benefit Package

Mental health education, screening, management of disorders
Rehabilitation for substance use disorders

Tariff:

Outpatient – Sh 1,200 per visit (limit of 7 visits)
Inpatient (per diem):
Level 4 – Sh 3,500
Level 5 – Sh 4,000
Level 6 – Sh 5,000
Detoxification – Sh 14,000
Rehabilitation – Sh 125,000

Surgical Services Package

Pre-operative care, minor, major, and specialized surgeries
Post-operative care, including follow-ups and pain management
Organ transplants and implants

Access Point: Level 3-6 facilities with appropriate equipment

Tariff: Based on a schedule of surgical procedures

Oncology Services

Cancer screening and treatment (breast, prostate, cervical, childhood cancers)
Administration of chemotherapy, radiotherapy, brachytherapy

Tariff:

Chemo administration – Sh 5,000
PET Scan – Sh 53,500
PSMA PET Scan – Sh 64,200
CT Scan – Sh 9,600
MRI – Sh 11,000

Medical Imaging and Other Investigations Package

Specialized imaging: MRI, CT scans, mammography, ultrasounds

Tariff:

MRI – Sh 11,000
CT Scan – Sh 9,600
CT Angio – Sh 8,000
Mammography – Sh 3,000

Pharmacy Package

Medicines for chronic conditions like diabetes, hypertension, asthma, renal disease, oncology, mental health, epilepsy

Tariff: Quarterly limit of Sh 5,000 per person

Specialized Laboratory Services

Laboratory tests for chronic conditions and select diseases

Tariff: Quarterly limit of Sh 5,000 per person

End of Life Services

Preparation, preservation, and storage of the body

Tariff: Sh 500 per day (limit up to 5 days)

Health CS Deborah Barasa during her swearing in ceremony at State House Health CS Deborah Barasa during her swearing in ceremony at State House Pulse Live Kenya