State Says It Will Only Cover Ksh10K for Normal Delivery Under SHIF
Starting next month, the government will cover Sh10,000 for any expectant woman delivering naturally and Sh34,200 for those undergoing a cesarean section as part of the new benefits package.
The new Social Health Insurance Fund (SHIF) managed by the Social Health Authority (SHA) will replace the NHIF in less than a month.
Women who give birth naturally will be covered for up to two days, while those having a cesarean section will be covered for three days. This coverage includes pregnancy emergencies like tranexamic acid and magnesium sulfate.
Mothers opting for private facilities might need to pay out of pocket, or hospitals may adjust their rates based on the Fund’s rates.
Under SHIF, services are funded by Primary Health Care (PHC) and SHIF funds depending on where the service is accessed. These services are available to all pregnant women and children at level 2 and 3 facilities, regardless of their contribution status. Antenatal and postnatal services will be covered on an outpatient basis at primary health care levels.
The package also includes services such as midwifery, operating theatre, recovery room, maternity ward, treatment rooms, meals and special diets, newborn immunization, diagnostic laboratory tests, and medical supplies and equipment.
Additionally, the coverage includes post-partum family planning, treatment of post-partum infections and hemorrhage, obstetric trauma, childbirth-related conditions, and obstetric and neonatal complications.
Public hospitals charge between Sh10,000 and Sh28,000 for a normal delivery and Sh30,000 for a cesarean section, whereas private facilities charge up to Sh125,000 for a normal delivery and Sh270,000 for a cesarean section.
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At Jacaranda Maternity Hospital, normal delivery costs between Sh18,000 and Sh25,000, and cesarean sections range from Sh41,000 to Sh55,000. St. Mary’s Mission Hospital charges between Sh10,000 and Sh13,000 for normal delivery and Sh20,000 to Sh25,000 for a cesarean section.
Despite the services being intended as free, pregnant mothers often have to pay in cash, particularly in emergencies. This financial burden has caused difficulties despite NHIF coverage, significantly straining mothers and their households.
Millicent Nyangaresi, a first-time mother who delivered at a level four hospital in Nairobi, shared her experience of stopping NHIF payments seven months before pregnancy. The penalty was substantial, so she paid in cash after delivery, expecting a Sh10,000 fee but ended up paying Sh25,000 due to complications, making the experience even more costly.
Private hospitals charge for delivery based on the level of care. For instance, Nairobi Hospital charges Sh125,000 for a normal delivery with a two-night stay, while Aga Khan University Hospital (AKUH) charges Sh108,550 for the same.
At Nairobi Hospital, a cesarean section costs Sh240,000 for a three-day stay, whereas at AKUH, the cost ranges from Sh206,850 in the general ward to Sh270,900 in a private room for the same period.
Coptic charges up to Sh35,000 for normal delivery in a ward bed for a single night and up to Sh65,000 for a cesarean section for two nights.
Marion, a mother of two, appreciates private hospitals for their attentive care, including food, attentive gynecologists, close monitoring of the healing process, and baby progress checks.
The Ministry of Health data shows that the number of Kenyans delivering by cesarean section has exceeded the World Health Organization’s (WHO) recommended limit, with the average C-section rate for Africa at around 9.2 percent.
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SHIF’s maternity services will be available to current members and their dependents.
Anti-D will only be provided to rhesus-negative mothers with prior authorization. The anti-D immunoglobulin neutralizes any Rhesus factor D (RhD) positive antigens that may enter the mother’s blood during pregnancy.
After childbirth, a woman previously considered a dependent must upgrade to a principal member to ensure continued coverage for herself and the baby, similar to the NHIF.
Maternal health is a major challenge in Kenya, with a maternal mortality ratio of 355 deaths per 100,000 live births, according to the United Nations Population Fund (UNFPA).
This situation threatens Kenya’s commitment to reduce maternal deaths to less than 70 per 100,000 live births.
To improve maternal healthcare, Kenya has implemented several health sector reforms. In 2013, the government introduced the Free Maternity Policy, offering free maternal health services in the public sector.
In 2017, the program’s management shifted to the National Health Insurance Fund (NHIF), resulting in the launch of ‘Linda Mama’, which expanded services and benefits.
The program was rolled out in three phases. The first phase began in April 2017, contracting private for-profit and faith-based health facilities through NHIF to provide maternity services.
The second phase started in July 2017, involving all public healthcare facilities in providing delivery services.
The third phase launched in March 2018, extending the benefit package to include antenatal care (ANC) and postnatal care (PNC) in contracted public, private, and faith-based healthcare facilities.
State Says It Will Only Cover Ksh10K for Normal Delivery Under SHIF