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SHA (Social Health Authority) System

A comprehensive Django-based management system for Kenya's Social Health Authority (SHA), replacing the former NHIF system. This system manages member registration, contributions, healthcare provider networks, claims processing, and payments.

👨‍💻 Developer Information

Developer: Steve Ongera
Email: steveongera001@gmail.com
Phone: 0112284093
Project Type: Healthcare Management System
Technology: Django + Python

📋 Table of Contents

🎯 Overview

The SHA System is a role-based healthcare management platform that digitizes and automates Kenya's Social Health Authority operations. The system handles:

  • Member Registration & Management - Principal members and dependents
  • Employer Integration - Company registration and salary deductions
  • Contribution Tracking - Monthly contributions at 2.75% of gross salary
  • Healthcare Provider Network - Facility registration and contract management
  • Benefit Packages - SHIF, PHCF, and ECCIF coverage
  • Pre-Authorization - Request and approval workflow for procedures
  • Claims Processing - Submission, review, approval, and payment
  • Payment Processing - Direct payments to healthcare providers
  • Eligibility Verification - Real-time member eligibility checks
  • Reporting & Analytics - Comprehensive system reports

✨ Features

Core Features

  • ✅ Role-Based Access Control (7 user roles)
  • ✅ Member registration with SHA number generation
  • ✅ Employer management and salary deduction tracking
  • ✅ Multiple payment methods (M-Pesa, Bank Transfer, USSD)
  • ✅ Healthcare provider network management
  • ✅ Three-tier benefit packages (SHIF, PHCF, ECCIF)
  • ✅ Pre-authorization workflow for specialized procedures
  • ✅ Multi-stage claims processing
  • ✅ Automated payment processing
  • ✅ Eligibility verification system
  • ✅ Comprehensive audit logging
  • ✅ Notification system
  • ✅ Report generation

Administrative Features

  • 📊 Dashboard with analytics
  • 🔍 Advanced search and filtering
  • 📈 Financial reporting
  • 🏥 Provider performance tracking
  • 👥 Member enrollment statistics
  • 💰 Contribution and claims summaries

💻 System Requirements

Prerequisites

  • Python: 3.9 or higher
  • Django: 4.2 or higher
  • Database: PostgreSQL 13+ (recommended) or MySQL 8+
  • OS: Linux, macOS, or Windows
  • Memory: Minimum 4GB RAM
  • Storage: Minimum 10GB available space

Python Packages

Django==4.2.0
djangorestframework==3.14.0
psycopg2-binary==2.9.6
Pillow==10.0.0
django-filter==23.2
django-cors-headers==4.0.0
celery==5.3.0
redis==4.5.5
python-decouple==3.8
gunicorn==20.1.0
whitenoise==6.4.0

🚀 Installation

Step 1: Clone the Repository

git clone https://github.com/yourusername/sha-system.git
cd sha-system

Step 2: Create Virtual Environment

# Using venv
python -m venv venv

# Activate on Linux/Mac
source venv/bin/activate

# Activate on Windows
venv\Scripts\activate

Step 3: Install Dependencies

pip install -r requirements.txt

Step 4: Create Environment File

Create a .env file in the project root:

# Django Settings
SECRET_KEY=your-secret-key-here
DEBUG=True
ALLOWED_HOSTS=localhost,127.0.0.1

# Database Configuration
DB_ENGINE=django.db.backends.postgresql
DB_NAME=sha_db
DB_USER=sha_user
DB_PASSWORD=your_password_here
DB_HOST=localhost
DB_PORT=5432

# Email Configuration
EMAIL_BACKEND=django.core.mail.backends.smtp.EmailBackend
EMAIL_HOST=smtp.gmail.com
EMAIL_PORT=587
EMAIL_USE_TLS=True
EMAIL_HOST_USER=your-email@gmail.com
EMAIL_HOST_PASSWORD=your-email-password

# M-Pesa Integration (for payments)
MPESA_CONSUMER_KEY=your_consumer_key
MPESA_CONSUMER_SECRET=your_consumer_secret
MPESA_SHORTCODE=your_shortcode
MPESA_PASSKEY=your_passkey
MPESA_CALLBACK_URL=https://yourdomain.com/api/mpesa/callback/

# Redis (for Celery)
REDIS_URL=redis://localhost:6379/0

# File Upload Settings
MEDIA_ROOT=media/
MEDIA_URL=/media/

🗄️ Database Setup

PostgreSQL Setup

# Login to PostgreSQL
sudo -u postgres psql

# Create database and user
CREATE DATABASE sha_db;
CREATE USER sha_user WITH PASSWORD 'your_password_here';
ALTER ROLE sha_user SET client_encoding TO 'utf8';
ALTER ROLE sha_user SET default_transaction_isolation TO 'read committed';
ALTER ROLE sha_user SET timezone TO 'Africa/Nairobi';
GRANT ALL PRIVILEGES ON DATABASE sha_db TO sha_user;
\q

Run Migrations

# Make migrations
python manage.py makemigrations

# Apply migrations
python manage.py migrate

Create Superuser

python manage.py createsuperuser
# Follow prompts to create admin account

Load Initial Data (Optional)

# Load sample benefit packages
python manage.py loaddata fixtures/benefit_packages.json

# Load sample services
python manage.py loaddata fixtures/benefit_services.json

⚙️ Configuration

settings.py Configuration

Update your settings.py:

# SHA System specific settings
SHA_CONTRIBUTION_RATE = 2.75  # Percentage
SHA_MINIMUM_CONTRIBUTION = 300  # KES

# Upload settings
MEDIA_ROOT = os.path.join(BASE_DIR, 'media')
MEDIA_URL = '/media/'

# File size limits
MAX_UPLOAD_SIZE = 5242880  # 5MB

# Session settings
SESSION_COOKIE_AGE = 3600  # 1 hour
SESSION_SAVE_EVERY_REQUEST = True

# Pagination
REST_FRAMEWORK = {
    'DEFAULT_PAGINATION_CLASS': 'rest_framework.pagination.PageNumberPagination',
    'PAGE_SIZE': 50,
    'DEFAULT_AUTHENTICATION_CLASSES': [
        'rest_framework.authentication.SessionAuthentication',
        'rest_framework.authentication.TokenAuthentication',
    ],
    'DEFAULT_PERMISSION_CLASSES': [
        'rest_framework.permissions.IsAuthenticated',
    ],
}

🏃 Running the Application

Development Server

# Run Django development server
python manage.py runserver

# Access admin panel
# http://localhost:8000/admin/

# Access API
# http://localhost:8000/api/

Run Celery (Background Tasks)

# Terminal 1 - Start Redis
redis-server

# Terminal 2 - Start Celery Worker
celery -A sha_system worker --loglevel=info

# Terminal 3 - Start Celery Beat (Scheduled Tasks)
celery -A sha_system beat --loglevel=info

Collect Static Files (Production)

python manage.py collectstatic --noinput

👥 User Roles

The system supports seven distinct roles:

Role Description Key Permissions
ADMIN System Administrator Full system access, user management
SHA_OFFICER SHA Government Officer Member management, policy oversight
EMPLOYER Employer/Company Employee registration, contribution submissions
PROVIDER Healthcare Provider Claim submission, eligibility checks
MEMBER Member/Contributor View contributions, view claims
CLAIMS_OFFICER Claims Processing Officer Review and approve/reject claims
FINANCE_OFFICER Finance Officer Payment processing, financial reports

📦 Key Modules

1. Member Management

Models: Member

  • Principal and dependent member registration
  • SHA number auto-generation (Format: SHA/YYYY/XXXXXX)
  • Employment status tracking
  • County-based registration
  • Government subsidy eligibility

2. Employer Management

Models: Employer

  • Company registration with KRA PIN
  • Employer code generation (Format: EMP/XXXXXX)
  • Bank details for remittance
  • Employee roster management

3. Contribution Management

Models: Contribution

  • Monthly contribution tracking
  • 2.75% salary deduction calculation
  • Multiple payment methods
  • Transaction reference tracking
  • Payment status management

4. Healthcare Provider Network

Models: HealthcareProvider

  • 6-level facility classification
  • Public, private, and faith-based facilities
  • License and contract management
  • Facility code generation (Format: FAC/XXXXXX)

5. Benefit Packages

Models: BenefitPackage, BenefitService

  • SHIF (Social Health Insurance Fund)
  • PHCF (Primary Healthcare Fund)
  • ECCIF (Emergency, Chronic & Critical Illness Fund)
  • Service-level tariffs and co-payments
  • Frequency and coverage limits

6. Pre-Authorization

Models: PreAuthorization

  • Request submission by healthcare providers
  • SHA officer review and approval
  • Authorization number generation (Format: AUTH/YYYY/XXXXXX)
  • Validity period tracking
  • Document management

7. Claims Processing

Models: Claim, ClaimItem

  • Outpatient, inpatient, and emergency claims
  • Claim number generation (Format: CLM/YYYY/XXXXXX)
  • Multi-stage workflow: Submitted → Under Review → Approved/Rejected → Paid
  • ICD-10 diagnosis coding
  • Item-level claim details
  • Supporting document management

8. Payment Processing

Models: Payment

  • Direct payments to healthcare providers
  • Payment reference generation (Format: PAY/YYYY/XXXXXX)
  • Bank transfer tracking
  • Payment status management
  • Transaction reconciliation

9. Eligibility Verification

Models: EligibilityCheck

  • Real-time member eligibility verification
  • Contribution status checking
  • Provider access control
  • Audit trail

10. Audit & Compliance

Models: AuditLog

  • Comprehensive audit trail
  • User action tracking
  • IP address logging
  • Change history

🔌 API Endpoints

Authentication

POST   /api/auth/login/           # User login
POST   /api/auth/logout/          # User logout
POST   /api/auth/register/        # User registration

Members

GET    /api/members/              # List all members
POST   /api/members/              # Create new member
GET    /api/members/{id}/         # Get member details
PUT    /api/members/{id}/         # Update member
DELETE /api/members/{id}/         # Delete member
GET    /api/members/{id}/dependents/  # Get member dependents

Contributions

GET    /api/contributions/        # List contributions
POST   /api/contributions/        # Submit contribution
GET    /api/contributions/{id}/   # Get contribution details
GET    /api/contributions/member/{member_id}/  # Get member contributions

Claims

GET    /api/claims/               # List all claims
POST   /api/claims/               # Submit new claim
GET    /api/claims/{id}/          # Get claim details
PUT    /api/claims/{id}/          # Update claim
POST   /api/claims/{id}/approve/  # Approve claim
POST   /api/claims/{id}/reject/   # Reject claim

Pre-Authorizations

GET    /api/preauthorizations/    # List pre-authorizations
POST   /api/preauthorizations/    # Submit pre-auth request
GET    /api/preauthorizations/{id}/  # Get pre-auth details
POST   /api/preauthorizations/{id}/approve/  # Approve pre-auth
POST   /api/preauthorizations/{id}/reject/   # Reject pre-auth

Eligibility

POST   /api/eligibility/check/    # Check member eligibility
GET    /api/eligibility/history/{member_id}/  # Get eligibility history

Payments

GET    /api/payments/             # List all payments
POST   /api/payments/             # Process payment
GET    /api/payments/{id}/        # Get payment details

Reports

GET    /api/reports/              # List available reports
POST   /api/reports/generate/     # Generate report
GET    /api/reports/{id}/download/  # Download report

🧪 Testing

Run Unit Tests

# Run all tests
python manage.py test

# Run specific app tests
python manage.py test sha.tests

# Run with coverage
coverage run --source='.' manage.py test
coverage report
coverage html

Test Data

# Create test data
python manage.py shell
>>> from django.core.management import call_command
>>> call_command('loaddata', 'fixtures/test_data.json')

🚀 Deployment

Production Checklist

  • Set DEBUG=False in .env
  • Configure proper ALLOWED_HOSTS
  • Set up HTTPS/SSL certificates
  • Configure production database
  • Set up Redis for caching
  • Configure Celery for background tasks
  • Set up email service (SMTP)
  • Configure file storage (AWS S3/Azure Blob)
  • Set up monitoring (Sentry)
  • Configure backup strategy
  • Set up firewall rules
  • Enable rate limiting

Deploy with Gunicorn

# Install Gunicorn
pip install gunicorn

# Run with Gunicorn
gunicorn sha_system.wsgi:application --bind 0.0.0.0:8000 --workers 4

Nginx Configuration

server {
    listen 80;
    server_name yourdomain.com;

    location /static/ {
        alias /path/to/sha-system/staticfiles/;
    }

    location /media/ {
        alias /path/to/sha-system/media/;
    }

    location / {
        proxy_pass http://127.0.0.1:8000;
        proxy_set_header Host $host;
        proxy_set_header X-Real-IP $remote_addr;
        proxy_set_header X-Forwarded-For $proxy_add_x_forwarded_for;
    }
}

Docker Deployment

FROM python:3.9

WORKDIR /app

COPY requirements.txt .
RUN pip install -r requirements.txt

COPY . .

RUN python manage.py collectstatic --noinput

CMD ["gunicorn", "sha_system.wsgi:application", "--bind", "0.0.0.0:8000"]

📊 Database Schema Overview

Users (Authentication & Roles)
  ├── Members (Principal & Dependents)
  │     ├── Contributions
  │     ├── Claims
  │     ├── Pre-Authorizations
  │     └── Eligibility Checks
  │
  ├── Employers
  │     ├── Members (Employees)
  │     └── Contributions
  │
  └── Healthcare Providers
        ├── Claims
        ├── Pre-Authorizations
        ├── Payments
        └── Eligibility Checks

Benefit Packages
  └── Benefit Services
        ├── Claims Items
        └── Pre-Authorizations

Payments
  └── Claims

Audit Logs (All Activities)
Notifications (User Alerts)
Reports (System Reports)

🔐 Security Considerations

  1. Authentication: Django's built-in authentication with token support
  2. Authorization: Role-based access control on all endpoints
  3. Data Encryption: Use HTTPS in production
  4. Sensitive Data: Encrypt sensitive fields (bank details, medical records)
  5. Audit Trail: Comprehensive logging of all actions
  6. Rate Limiting: Implement API rate limiting
  7. Input Validation: Strict validation on all user inputs
  8. File Uploads: Validate file types and sizes
  9. SQL Injection: Use Django ORM (parameterized queries)
  10. CSRF Protection: Enabled by default in Django

📝 Important Notes

SHA Number Format

  • Format: SHA/YYYY/XXXXXX
  • Example: SHA/2024/000001
  • Auto-generated on member registration

Contribution Calculation

  • Rate: 2.75% of gross salary
  • Minimum: KES 300 per month
  • Payment methods: Salary Deduction, M-Pesa, Bank Transfer, USSD

Claim Processing Workflow

  1. Submitted - Provider submits claim
  2. Under Review - Claims officer reviews
  3. Queried - Additional information needed
  4. Approved - Claim approved for payment
  5. Rejected - Claim rejected with reason
  6. Paid - Payment processed to provider

Benefit Packages

  • SHIF: Main outpatient and inpatient coverage
  • PHCF: Primary and community health services
  • ECCIF: Emergency, chronic, and critical illness care

🤝 Contributing

Contributions are welcome! Please follow these steps:

  1. Fork the repository
  2. Create a feature branch (git checkout -b feature/AmazingFeature)
  3. Commit your changes (git commit -m 'Add some AmazingFeature')
  4. Push to the branch (git push origin feature/AmazingFeature)
  5. Open a Pull Request

Coding Standards

  • Follow PEP 8 style guide
  • Write unit tests for new features
  • Update documentation
  • Use meaningful commit messages

📞 Support & Contact

Developer: Steve Ongera
Email: steveongera001@gmail.com
Phone: +254 112 284 093

For bug reports and feature requests, please create an issue on GitHub.

📜 License

This project is proprietary software developed for Kenya's Social Health Authority (SHA).
All rights reserved © 2024 Steve Ongera

🙏 Acknowledgments

  • Kenya Social Health Authority (SHA) for system requirements
  • Django community for the excellent framework
  • Contributors and testers

📚 Additional Resources

Last Updated: December 2024
Version: 1.0.0
Status: Production Ready

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A comprehensive Django-based management system for Kenya's Social Health Authority (SHA), replacing the former NHIF system. This system manages member registration, contributions, healthcare provider networks, claims processing, and payments.

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