For years, AoN Minet served as the trusted medical cover for Kenya’s civil servants. Not to say it was perfect, but it at least offered predictability and security to a group already stretched thin financially. I am talking about teachers, the police force – you know, civil servants. So why is it now being shut down and being replaced with the Social Health Authority (SHA) scheme?
There seems to be a lot of confusion surrounding this exodus, and no one is even giving straightforward answers. Why does the government feel the need to replace a system that was working? What benefits, if any, will the new SHA offer? And most importantly, how will this affect civil servants, who as we all know, are already underpaid and heavily reliant on their medical cover?
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The other day, I jokingly pointed out on my WhatsApp status that this government has a peculiar habit of restructuring and renaming what already works. The post was made in zest, until a few days later when I sat up, in darkness, on my bed because it suddenly hit me at that odd hour, that there definitely was a reason behind it all. There must be a reason why Kenyan governments ALWAYS either want to rename a program that works, restructure it or replace it. NHIF became SHA, Linda Mama became Linda Jamii, and now AoN is being phased out. On the surface, these changes are presented as improvements or modernization.
But if you look closer, a pattern emerges.
Rebranding offers governments a visible win. It is their way to claim credit for reforms without building anything entirely new. It is them trying to show who is boss. Look, we are making change happen. No matter what angle you look at it from, it is a win win for them because for the public a new name and a new system often feel more tangible than genuine improvements. And say, even if they make genuine improvements for projects previous governments started, will they ever get any credit for them? Of course not.
Unfortunately, civil servants are often the people that bear the brunt the most. What was once functional becomes uncertain because it carries a new label and a new set of rules. In this sense, the politics of rebranding is less about efficiency and more about control and perception. It is to hoodwink the public. Mind games and illusions.
Have you ever wondered why since all this SHA business started not a single day has passed without an ugly politic about it coming up? It’s been constant fights among politicians calling each other names, doctors making grand dramatic scenes and what have you and what have you. This is because Health insurance in Kenya is big business. Matter of fact, health insurance anywhere in the world is big business. (Think about all the drama there was with Obama care.)
Changing systems often means billions of shillings changing hands. AoN Minet handled substantial contracts for civil servants’ medical cover, that is a fact. But you need to realize, that the government’s move to SHA opens the door for new tenders, new vendors and new procurement opportunities. It is all about the money trail. Each time a system is replaced, there’s a fresh injection of funds and with it, a host of administrative, technological and service contracts. While the official narrative emphasizes efficiency and universality, chini ya maji the story is different. It is, after all, every new government’s time to eat, just like those before them did.
The reality is that large scale reforms often create opportunities for financial and political gains.
Civil servants, who rely on these schemes for their health and wellbeing, rarely see this side of the story. They experience the change as new rules and potential service disruptions. Meanwhile the bigger financial machinery quietly moves behind the scenes. Understanding the money trail helps explain why systems that were already functioning are suddenly deemed in need of replacement.
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While it’s all about politics and finances, another key player is – obviously – control. By moving civil servants from AoN to SHA, the government consolidates authority over so many things. Medical coverage, funds, data. A centralized system allows the state to manage revenue streams and monitor claims. It also enforces policies more efficiently all under one roof.
Centralization gives the government stronger narrative power. It can confidently claim that “all civil servants now enjoy standardized, universal coverage.” Mind less the fact that operational realities are still shaky.
I am not saying that centralization is a bad thing. It does have its theoretical benefits. However, the transition poses risks. Hospitals must adjust to a new payer, staff must learn new protocols and civil servants must deal with unfamiliar processes. In practice, what should be a smooth policy reform can quickly become disruptive for the people who rely on it most.
If I say AoN was perfect I would be lying. It did have its downside. But, for many civil servants, AoN Minet was reliable and predictable. It was comprehensive. It covered both inpatient and outpatient services, meaning routine check-ups, doctor visits, prescriptions and hospitalization were all taken care of under a single scheme.
This level of coverage provided peace of mind for workers already stretched thin financially ( I keep repeating this “stretched thin financially” bit because it is true. Civil servants are highly underpaid, but that is a story for another day.) Knowing that both minor ailments and major medical emergencies were included allowed civil servants to focus on their jobs without fearing astronomical medical bills.
In contrast, SHA currently covers only inpatient services. Routine outpatient care that we all know most civil servants and their families need regularly will now require out of pocket payments. Jameni!
AoN was working well enough that a significant portion of civil servants trusted it. So why does the government feel the need to make these changes, despite its relative success? Are we sacrificing functioning coverage for centralization and consolidation?
Maybe, yes, that is what is why all this is happening. But, and it is a strong but, SHA needs legitimacy and so they must move numbers.
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SHA is the government’s flagship health insurance initiative. And by fire by force, by whatever means necessary (like any new system) it needs credibility to succeed. One way to build that legitimacy is by enrolling a large, stable and easily trackable group. And who better fits that description? Civil servants. They fit the bill perfectly.
Salaried workers with predictable incomes are easy to integrate into a centralized system. Their contributions can be deducted automatically and their participation creates impressive headline numbers for the government to tout. Just imagine the title. “Millions of Kenyans now covered under SHA.”
Reminds one of the affordable housing deductions, right?
In layman terms, civil servants are the perfect guinea pigs for a political showcase. But while the government benefits from higher enrollment figures and positive optics, the workers themselves face uncertainty.
What am I even saying? That civil servants are being targeted not necessarily because the system needed them, but because SHA needs them to appear successful. Civil servants are a convenient target for systemic reforms because they are organized yet dependent and their salaries make them easy to enroll and track. They are expected to participate fully in government programs (from deductions to mandatory schemes), leaving them little room to negotiate.
There was nothing fundamentally wrong with AoN Minet. Civil servants received reliable coverage for both inpatient and outpatient services. And with it, at least hospitals respected its agreements and workers trusted it.
In other words, AoN wasn’t failing. Its only mistake was being too effective and independent. Replacing it with SHA is not really about fixing a broken system per se. It’s about bringing civil servants and their money under government managed control. A move that admittedly comes with both political and financial incentives.
Well, as usual, us citizens can only sit and watch everything unfold.
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