New health scheme is meant to replace NHIF and achieve the government’s universal health care plan, but there are many questions surrounding it.
The challenges faced by patients seeking medical services in both public and private hospitals across Kenya continue to mount, with many being forced to pay cash to access treatment.
This follows the chaotic implementation of the Social Health Authority (SHA) insurance services, leaving many health facilities struggling to adapt.
In Nairobi, patients face long queues, delayed services, and being turned away for lack of referral letters, highlighting the capital’s share of the nationwide crisis.
The Nation.Africa team reached out to patients Narok, Nairobi, Bomet, Kericho, Kisumu, Siaya, Mombasa, and Kwale counties to understand if the new system (SHIF) is delivering on its promises or merely compounding their struggles.
In Nairobi, at Kenyatta National Hospital (KNH) in Nairobi, the country's largest referral facility, the day runs like any other, busy corridors, a steady flow of patients, and long queues at the cashier's office. Among the many waiting is Mr Evan Mutwiri, anxiously staring at his phone, refreshing his screen for a one-time pin (OTP) message that will enable him to clear his hospital bill.
Despite receiving his discharge paperwork in the morning, Mutwiri has been stuck for over 47 minutes, unable to leave until the payment process is completed. His frustration is palpable.
“You know, this is a struggle,” he says, gesturing toward the growing queue behind him. “Why do we have to implement a trial-and-error system with Kenyans’ lives? Even getting a response takes forever. Someone can spend the whole day here waiting for this OTP message. We need a quicker way of making payments in hospitals,” he laments.
Mutwiri's ordeal reflects a broader issue affecting patients in public hospitals across the country. The payment systems introduced under the Social Health Authority (SHA) have become a bottleneck, causing unnecessary delays and frustration.
Patients at KNH, like many others nationwide, are grappling with the inefficiencies of a system that appears ill-prepared to handle the realities of healthcare access.
For patients in critical need or those discharged but unable to leave, these delays are more than an inconvenience—they represent a failure of the system meant to make healthcare more accessible.
In the South Rift, public hospitals such as Narok County Referral Hospital, Kericho County Referral Hospital, and Longisa County Referral Hospital were significantly affected. Private hospitals, including AGC Tenwek, AIC Litein, St Clare's Kaplong, Siloam Hospital, and St Luke Hospital, have also reported challenges.
Despite the growing concerns, hospital administrators were reluctant to speak on the record, citing fear of government backlash. This silence underscores the complexity of the situation as patients bear the brunt of the system’s shortcomings.
Mr Stephen Koech Kimetet, a resident of Chebole in Sotik constituency, Bomet County was involved in an accident on October 3, 2024, while riding on a boda boda (motorcycle).
“I was rushed to Longisa County Referral Hospital with a broken right hand, but I was informed that I could not use SHA insurance cover because I was an outpatient and since I had not been referred from a health centre,” Mr Kimetet said.
As a result, his children spent a cumulative Sh8,000 for treatment at the hospital before being discharged.
“On November 15, 2924, I went for a scheduled checkup at the hospital and I was still told that I could not use the SHA insurance card as he was not referred from a health centre,” Mr Kimetet said.
He added: “I was asked to pay Sh 500 in cash for treatment, money which I did not have at the time. I had to ask my children to send me the amount required.”
It would have cost him Sh 400 to travel back to a health centre in his village to get the referral to Longisa County Hospital.
“Unfortunately, President William Ruto and senior government officers continue to lie over the state of health facilities and SHA in the country when thousands of people are suffering for lack of medication, hundreds with complications are dying,” Mr Kimetet said.
He wondered, “Why should a person who has health complications or one who has a medical record, one who is involved in emergency cases be asked for a referral from a health centre? These clear and serious hiccups should be addressed as a matter of priority and safe people’s lives”.
Ms Irene Chebet, a resident of Kaitui in Kericho County said it was unfortunate that President Ruto’s administration had rushed the shift from NHIF to SHA without considering the hardships patients would face.
“What were the reasons for rushing the transfer of the system without piloting it to ensure seamless operations in hospitals? Is Dr Ruto aware that many people have died, some have developed serious health complications for failure to access treatment in hospitals?” Ms Chebet wondered.
Mr Bildad Cheruiyot, a resident of Bomet said the private hospitals were turning away patients despite the demand by the President and technocrats that no one should be discriminated against as the old system under NHIF would be applicable in the facilities.
“Majority of the elderly people and those living with disabilities who are not conversant with the Information Communication Technology (ICT) being used to register beneficiaries under SHA have been left out in what has discriminated against them in medical treatment,” Mr Cheruiyot said.
In Nyandarua and Samburu counties, patients face hurdles that disrupt access to essential medical services, with many relying on cash payments and support from hospital staff to navigate the new system.
Many patients like Winnie Mwangi were caught off guard and faced significant challenges during the transition from the National Hospital Insurance Fund (NHIF) to the Social Health Insurance (SHA) system.
Ms Mwangi, who was visiting Nyahururu Hospital for an ante-natal care clinic, expressed her frustration.
“I’ve tried several times for over a week to register with the new health system, but the portal keeps hanging. Today, I came hoping to be attended to, only to find out that NHIF cards are no longer working,” she said.
But despite the setbacks, she praised the hospital staff, noting, “nurse kindly assisted me in registering with SHA.”
Other patients eager to avoid delays in receiving treatment resorted to paying out of pocket.
Wilfred Karweni, who was at the hospital for hand physiotherapy also shared his experience.
“The total cost of treatment and drugs was Sh2,100, which I paid in cash. I attempted to register with SHA but faced poor connectivity, so I had no choice but to pay directly,” he said.
In Samburu, the county referral hospital launched a registration initiative for the Social Health Authority (SHA) to assist community members, especially those in underserved areas, in securing essential health coverage.
Samburu Executive for Health, Nassir Lekudere, expressed optimism that SHA would help bridge the healthcare gap in the pastoral region. Despite the ongoing transition from the National Health Insurance Fund (NHIF) to the SHA, the hospital continues to provide critical services, including kidney dialysis, cancer care, and maternity services.
The high cost of medical care, coupled with a lack of awareness about social health options, has left many families struggling to afford treatment.
As the shift from the previous National Health Insurance Fund (NHIF) to the Social Health Insurance Fund (SHIF) is taking shape, there are numerous challenges that the members of the public still face.
Previously, according to patients who spoke to Nation.Africa, the processing of payment via the NHIF was fast and seamless in both private, mission and public health facilities.
Mr Chrispine Owoko 62, from Gem Sirembe, was diagnosed with Glaucoma in 2019 and had been depending on the NHIF to offset bills whenever he visited facilities for check-ups.
“Most of the private facilities that accepted NHIF are yet to accept SHIF, this is the major challenge. It has pushed me to reduce the number of times I attend checkups. Initially, I visited the opticians once a month,” said Mr Owoko, a retired teacher.
He reports that he had to miss the October checkup and he is likely to miss November owing to the financial strain.
“The public facilities cannot offer the services that I need. I either get it from a private facility or a Mission hospital and currently, they haven’t begun processing the SHIF,” he added.
But the story is different for Seline Atieno, 57, who suffers from high blood pressure and diabetes.
She managed to get services from Siaya County Referral using the SHIF, however, but lamented the absence of drugs from the hospital shelves.
“The process was fine. The doctors checked me and I appreciated the SHIF for that, however, the drugs aren’t on the shelves and I was forced to buy from a private chemist which cost me a lot of money,” she said.
For Mr Dan Odede, a resident of Kisumu County, the transition from NHIF to SHIF has been a nightmare hence painting a grim picture of the state of healthcare in the county.
Mr Odede has a wife who is suffers from kidney complications and requires regular dialysis.
"It has been a great challenge for me since it came at a time when my wife was on dialysis. Before the transition, NHIF was giving us great support for every session the wife would go for treatment," he said.
But with the challenges that have been facing the new scheme, Mr Odede has been forced to make cash payments for the sessions the wife goes through.
"For me, it has been a challenge. We had to seek financial assistance from friends and relatives to pay for the two sessions in a month," said Mr Odede.
In a month, the wife needs to go for dialysis twice. Each session costs at least Sh7000.
He says most of the hospitals highlighted the failure of SHIF to remit funding.
Mary Otieno is facing a similar challenge with SHA insurance.
She had brought a patient diagnosed with cancer who had an appointment last week.
However, with the hitches facing the insurance system, they could not get medical attention.
"First they told us the medicine was not available and that we should come for them today. When we arrived, we were told the new insurance system had not been reflected," she said.
In Kilifi County, dialysis patients complained that the new health insurance was not as comprehensive as NHIF used to be.
One family said they decided to take their kin to a herbalist in Tanzania after they faced challenges with SHIF, coupled with an earlier equipment failure at the county hospital.
Mr Hamisi Ali, a relative of the patient, said SHIF does not cater for all dialysis and medication requirements as compared to NHIF.
“NHIF used to fund Sh9,500 per session and the patient had two sessions per day. This is not so under SHIF,” he said.
Mr Ali added that the patient has been strictly on herbal medication and has not suffered any health complications.
A patient who requested to remain anonymous for fear of being victimised said under NHIF, they used to get all services including medicines.
The patient said SHIF has complicated matters for many of them, especially those who cannot afford to purchase medicines out of pocket.
“NHIF used to pay for dialysis and medicines. Now we have people doing dialysis with no money for medicines, they’re just at home with no medication,” said the patient.
In Mombasa, an earlier situation whereby the number of expectant mothers was reduced at the start of the implementation of SHIF has improved.
A health worker at the Coast General Teaching and Referral Hospital told Nation. Africa the mothers are now receiving services paid for by SHIF.
She added that they were required to pay Sh3,000 to SHA, an amount that caters for maternity services for a period of one year.
By Vitalis Kimutai, Waikwa Maina, Geoffrey Ondieki, Kassim Adinasi, Elizabeth Ojina, Maureen Ongala and Angela Oketch
