A patient arrives at a hospital somewhere in Kenya. Perhaps she needs an operation. Or chemotherapy. Perhaps she has brought her child to hospital with a fever.
She did as the government instructed and registered with the Social Health Authority (SHA) and paid the subscription.
Now she needs treatment. There is supposed to be a computer linked to a network where her name and details can be found in a minute. The system behind it comes with a Sh104.8 billion price tag.
“Something is rotten in the state of Denmark,” Marcellus says in William Shakespeare’s Hamlet , after the guards encounter the ghost of the dead king. He cannot yet explain what is wrong but he knows only that something in the machinery of the state does not add up.
In 2024, as Kenya prepared to replace the National Health Insurance Fund (NHIF) with SHA, the government signed a Sh104.8 billion contract for a healthcare information technology digitisation system. The deal was not included in that year's procurement plan or medium-term budgetary expenditure framework, although government inked it through a specially permitted procedure. The contract also did not specify the number of public facilities to be installed or health workers to be trained.
The contract prohibited government from developing another system or product with similar functionalities that would compete with the system being procured. The Auditor-General warned that such a restriction could expose government as technology and requirements changed.
Now, two years later, hospitals are being moved from one SHA computer system to another. The government had set September 30 as the deadline but, last Thursday, extended it by another month because some facilities still needed technical assistance.
Kenya has spent a fortune on building a digital health system. The original contract was supposed to include an electronic system for managing health information. Yet hospitals are now being moved from one system to another, never mind that hospitals that already have their own systems are being asked to seek approval for them. It is not yet clear how all these systems fit together, what the Sh104.8 billion actually paid for, and how much the ongoing migration will cost.
Health Cabinet Secretary Aden Duale directed facilities in March not to deny patients treatment because of system downtime arguing that technical challenges could not be used as a reason for turning patients away.
For the patient, “the system is down” often means there will be no service. Or that the doctor cannot proceed. It can also mean the authorisation has not come. Or, worse, pay first. It could mean spending the night outside a hospital waiting for a computer to confirm that one is entitled to treatment. This is where the promise of universal healthcare becomes hollow.
The Kenya Network of Cancer Organizations told Parliament that 65.3 per cent of patients in its 2025 survey had experienced delays in SHA approvals, while 60.2 per cent had been denied treatment at least once because of SHA system failures. The submission included accounts of patients facing lengthy waits for authorisation.
This is what the Sh104.8 billion was supposed to buy. The patient is not a messenger between the hospital and SHA. She should not have to prove to the hospital that she is covered. The hospital should know that.
She should not have to wait three days because an electronic authorisation is stuck somewhere mid-air.
And when the hospital treats her, it should be able to submit a legitimate claim and receive payment. That is value for money.
The comparison of SHA with NHIF cannot simply be dismissed as nostalgia for the old system. NHIF had major weaknesses, including fraud, bureaucracy, claims disputes and administrative problems. There was a perfectly justified case for reforming it.
But NHIF also had something a new system inevitably lacks: institutional memory. Providers had established relationships with it; hospitals had built routines around its claims and reimbursement processes. Its flaws were the reason for reform.
The patient has no interest in the digital infrastructure. All she wants to know is whether or not she will be treated. If the Sh104.8 billion contract already factored in HMIS functionality, is the system to which hospitals are now being migrated a component of the original contract, a later stage of the same system, or something additional?
In July, the ministry's own healthcare IT steering committee was still dealing with technical, contractual, financial and operational issues involving the Safaricom consortium and the health agencies. In September, the new SHA contracting framework acknowledged provider concerns over claims processing, payment delays, pre-authorisation and system reliability.
Is the digital system serving healthcare, or is healthcare being reorganised to serve the digital system?
The Auditor-General has said value for money could not be confirmed in the Sh104.8 billion spending. If, two years after the transition from NHIF to SHA, Kenya is still moving hospitals from one digital platform to another, taxpayers deserve an explanation of what exactly was bought the first time.
The ghost is not in the machine. It is the patient standing outside the hospital, waiting for the machine to decide whether she can be treated.
The writer is a board member of the Kenya Human Rights Commission and writes in his individual capacity. @kwamchetsi; [email protected]
