SHA from the SWE Perspective: A Comparative Analysis

The development and rollout of large-scale systems, whether for technology or social infrastructure, require careful planning and execution. As Software Development Lifecycle stipulates a structured approach to building robust and scalable systems. However, the Kenyan New Social Health Authority (SHA) system has faced significant challenges, raising questions about its development process and government management (as a service provider). This short piece compares the SHA system as we know it now, against the principles of a software system design to identify potential lapses and areas for improvement. 
Proper System Design Approach The article referenced below outlines a comprehensive system design master template, a roadmap to developing proper systems the SDLC way, emphasizing the importance of: 

Proper System Design Approach 
The article referenced below outlines a comprehensive system design master template, a roadmap to developing proper systems the SDLC way, emphasizing the importance of: 

• Scalability: Designing systems that can handle increasing demands and user traffic.
• High Availability: Ensuring continuous system operation and minimizing downtime.
• Traffic and Task Management: Efficiently handling user requests and system processes.
• Performance Optimization: Maximizing system speed and responsiveness.
• Feature Expansion: Planning for future system growth and new functionalities.
• Security and Monitoring: Implementing robust security measures and continuously monitoring system health.

SHA Challenges

The Kenyan SHA system, intended to provide universal health coverage, has encountered numerous challenges. I highlight some of them below.

• Public Confusion and Lack of Trust: Many Kenyans lack a clear understanding of the SHA system, its benefits, and its relationship with NHIF, a previous healthcare scheme. This lack of clear communication has led to distrust and reluctance to enroll. 
• Inadequate Coverage: Patients report that the SHA benefits do not meet their needs, with essential treatments and medications often excluded, forcing them to pay out-of pocket. 
• Poor Service Delivery: Healthcare facilities continue to struggle with inadequate infrastructure, understaffing, and delays in providing timely care, leading to patient dissatisfaction. 
• Financial Burden: Despite the goal of reducing financial strain, many Kenyans still face high medical costs not covered by SHA. 
• System Failures: Technical and system issues have hindered access to healthcare services, with patients being turned away from hospitals. 
• Corruption and Mismanagement: A significant portion of Kenyans perceive corruption and mismanagement as major issues affecting the SHA system. 
• Complex Registration Process: The registration process is seen as complex and confusing, particularly for those in the informal sector.

Comparison and Analysis

Comparing the SHA system's challenges with the principles of a system design from software engineering viewpoint reveals potential development lapses.

• Scalability and High Availability: The reported system failures and inability to handle patient load suggest a lack of focus on scalability and high availability during the system's design and implementation.
• Traffic and Task Management: Delays in service delivery and bureaucratic hurdles indicate inefficiencies in traffic and task management.
• Performance Optimization: The slow and cumbersome processes point to a need for performance optimization. 
• Communication and Transparency: The widespread confusion about the system highlights a failure in communication and transparency, which are crucial aspects of any well-designed system. 
• Government Management Issues: The reports of corruption and mismanagement point to severe issues in the governance and oversight of the SHA system.

The Kenyan SHA system, while intended to improve healthcare access, has faced significant challenges as listed above. A comparison with best practice in system design, especially of such magnitude, suggests potential lapses in its development, particularly in areas of scalability, availability, traffic management, and communication. The implementers face allegations of corruption and mismanagement which have severely hampered the system's effectiveness. I believe that addressing these systemic issues and adopting a more structured approach to system design and governance are crucial for the SHA system to achieve its intended goals.

Reference
System Design Master Template - https://www.educative.io/blog/system-design
template