SURVEY REVEALS CRITICAL CHALLENGES IN ROLLOUT OF SOCIAL HEALTH AUTHORITY IN KENYA.
BY NJOKI KARANJA.
A recent survey conducted by the Caucus of Patient-Led Organizations of Non-Communicable Diseases (NCDs) has uncovered serious shortcomings in the implementation of Kenya’s Social Health Authority (SHA) and Social Health Insurance Fund (SHIF), particularly in the counties of Nairobi, Kiambu, Meru, and Bomet. The findings, based on data collected between October 24 and October 25, 2024, highlight significant barriers that patients, especially those with chronic conditions such as cancer, diabetes, and heart disease, are facing in accessing essential healthcare services.
The survey found that patients in public hospitals, including Kenyatta National Hospital and Kenyatta University Referral Hospital, were often left waiting for hours due to technical failures and system inefficiencies. In some instances, these delays led to severe distress and disruptions in critical medical services like diagnostic imaging and specialized procedures.
Meanwhile, patients seeking care in private hospitals reported another challenge: limited SHIF coverage, which was restricted to civil servants in certain job groups. This exclusion left many NCD patients, particularly those in need of life-saving treatments such as cancer therapies or organ transplants, struggling to pay for services out-of-pocket. This gap in coverage has led to a growing reliance on personal finances, reversing the financial protections that the National Hospital Insurance Fund (NHIF) had previously provided.
Mission hospitals, such as Tenwek Hospital, were also found to have no SHIF coverage, leaving rural populations particularly vulnerable. In urban public hospitals like Mama Lucy Kibaki and Mbagathi, critical procedures like cardiac surgeries were unavailable for SHA-covered patients, further compounding the healthcare challenges faced by individuals with NCDs.
Additional concerns raised by the survey include the suspension of overseas treatment coverage under SHA, which leaves patients with complex conditions, who require care unavailable in Kenya, with no options for treatment abroad. The survey also revealed that patients now face increased out-of-pocket expenses for primary healthcare services and routine drug refills—costs that were previously covered under NHIF. Adding to the uncertainty, healthcare providers noted the accumulation of unpaid NHIF debts and unclear SHA benefit structures, leading to hesitation in accepting SHA patients due to fears of non-reimbursement. This has placed further financial strain on both providers and patients.
In light of these challenges, the Caucus of Patient-Led Organizations has called on the Ministry of Health and SHA management to take immediate action. Key recommendations include: reinstating overseas treatment coverage for patients requiring specialized care unavailable locally; clarifying SHA benefit structures to ensure transparency and patient confidence in the system; addressing system failures to reduce delays and streamline patient access to services; settling outstanding NHIF debts to improve provider participation and reduce patient costs; launching public awareness campaigns to educate the public on SHA benefits and eligibility requirements; and engaging patient organizations to ensure that patient needs and concerns are central to the ongoing rollout.
Evans M. Majau, Chair of the Caucus, emphasized the urgency of these reforms: “The survey findings reveal critical gaps in SHA’s ability to serve Kenyan patients effectively, especially those facing chronic and complex conditions like cancer, diabetes, and cardiovascular diseases. The SHA rollout must prioritize transparency, access to specialized care, and patient inclusion to fulfill the promise of universal health coverage in Kenya.”
The Caucus remains committed to advocating for an equitable healthcare system, urging swift corrective action to ensure that all Kenyans, particularly those with chronic illnesses, have access to timely and affordable healthcare services.
