Patients’ pains increase as ‘slow’ Shif SMS verification bites
The recent shift from National Health Insurance Fund to Social Health Authority has been met with confusion and frustration among Kenyans.
What you need to know:
- Introduced under Shif to enhance security and accountability, the system has faced significant challenges in practice
- Patients have reported delays in receiving OTPs due to technical glitches, network issues, and system inefficiencies
Hospitals’ use of passcodes as a prerequisite for patients to access healthcare services has become a significant challenge.
The adoption of One-Time Pin (OTP) system has occasioned widespread delays and frustration among patients and healthcare providers.
Introduced under the Social Health Insurance Fund (Shif) to enhance security and accountability, the system has faced significant challenges in practice.
Patients have reported delays in receiving OTPs due to technical glitches, network issues, and system inefficiencies, which disrupt the timely delivery of healthcare services.
“These delays are particularly concerning in high-pressure environments such as emergency departments, where time is critical. Currently, when you get to the hospital, a one-time pin is generated and one needs to get that before treatment commences, this is delaying treatment,” said Dr Brian Lishenga, National Chairman of Rural-Urban Private Hospitals Association.
Unlike the National Health Insurance Fund (NHIF), where hospitals used a biometric verification system, patients now have to persevere, especially in facilities with high patient volumes, as they wait for OTPs to be generated, sent via mobile networks, and verified before receiving care.
Under NHIF, the biometric verification system allowed patients to access services almost instantly. By scanning fingerprints, healthcare providers could authenticate a patient’s identity in seconds, enabling real-time access to treatment.
“This growing inefficiency underscores the need for a more reliable and streamlined verification process to ensure patients receive timely, uninterrupted care. The system is even worse than the previous one,” said Dr Lishenga.
Ms Millicent Wanyoike has been a victim of the system twice.
“The first time, the message came back after 30 minutes. Imagine having a sick child and being forced to wait that long,” she recalled.
“The second time was during my monthly review, which was even worse. I waited for 45 minutes, only to be told the system was down. Why can’t we just use the NHIF biometric system to identify patients? Why take this longer, inefficient route?” she asked, frustration evident in her voice.
In some cases, especially in rural areas with poor network coverage, the delays can stretch to hours, leaving critically ill patients in limbo.
Healthcare providers, too, are feeling the pinch.
“We spend more time verifying OTPs than attending to patients. The biometric system was seamless and quick. Now, our workflow is heavily disrupted. The government overlooked the efficiency of the biometric system, which was more suited to real-time healthcare needs,” Dr Lishenga said.
For many Kenyans, especially those relying on public healthcare facilities, the delays mean longer queues, missed appointments, and compromised health outcomes.
“We need a responsive, efficient, and patient-centred verification system. We must ensure that no Kenyan is denied timely access to healthcare due to technical inefficiencies,” he said.
This is happening at a time when access to outpatient care at major public hospitals in the country has become more difficult than before due to rigid implementation of the Social Health Authority Act that discourages walk-in patients at levels four, five and six.
Sick Kenyans have been bearing the brunt of the rigidity as lower-level hospitals, where they are to access outpatient care, have few drugs, and equipment and face staff shortages.
After the story was published by the Nation, the government has now authorised Kenya Essential Package for Health (Keph) level four hospitals to directly provide outpatient services under the SHA framework, a significant development aimed at expanding healthcare coverage across the country.
A letter to all contracted Keph level four facilities dated November 15, the State, through the SHA, has invited the hospitals to offer primary healthcare outpatient services under the SHA.
It says the move is part of the government's broader commitment to universal healthcare, as embodied in the recently enacted Social Health Insurance (SHI) Act, which was signed into law on October 19.
The SHI Act aims to improve healthcare financing for all Kenyans and long-term residents and to ensure equitable and sustainable healthcare services.
The SHI Act has established three dedicated health funds, including the Primary Healthcare Fund (PHC), the Social Health Insurance Fund, and the Emergency, Chronic, and Critical Illness Fund, with each fund targeting specific health needs.
PHC focuses on the purchase of primary healthcare services from designated levels two and three health facilities, funded through allocations from the National Assembly.
“The Authority is committed to expanding access to quality healthcare services throughout the country, and therefore Keph level four facilities are eligible to provide outpatient PHC services in addition to the existing services at Keph levels two and three facilities.
“By expanding access to level four facilities, the SHA aims to bring essential outpatient care closer to communities, especially in underserved areas, thereby improving overall health outcomes,” said Robert Ingasira, the acting chief executive officer of SHA, in the letter.
Leve four hospitals
This initiative signals a shift in Kenya's healthcare landscape, as level four facilities - previously limited to more specialised care - can now provide routine outpatient services to citizens across the country.
For Keph level four facilities interested in participating, SHA has outlined a clear process.
Facilities must confirm their participation in writing and ensure alignment with the approved standards for outpatient PHC services as detailed in the gazetted guidelines.
Contracts will then be amended to include provision of these outpatient services for those who opt in.
Payment for these outpatient services will follow a capitation model where facilities will be paid a fixed amount per patient registered under the PHC scheme.
Payments will be made according to standard SHA reimbursement schedules, ensuring predictable financial support for participating facilities.
Under this model, only registered SHA members are eligible for services, including members of government-subsidised categories such as expectant mothers, children, elderly and other vulnerable groups.
Importantly, SHA regulations stipulate that no registered patient should be denied services based on membership status or outstanding contributions.
“With this move, the government reaffirms its commitment to access, equity and quality of health care. Keph level four facilities are encouraged to participate in this initiative, which will have a profound impact on Kenya's health system by improving access to essential services for all citizens,” Mr Ingasira added.
The latest development comes just hours after concerns were raised that access to outpatient care at major public hospitals has become more difficult than before due to the rigid implementation of the new Medical Schemes Act, which discourages walk-in patients at level four, five and six hospitals.
Dr Brian Lishenga, chairman of the Rural, Urban and Private Hospitals, noted that patients with chronic illnesses who require outpatient services risk suffering more because lower-level hospitals have no history of their conditions and may miss out on critical treatment.
“If we had a proper patient registry, their history would have been captured in the SHA portal, which then would allow them to be treated and seen at level four hospitals. It is only at higher levels that their conditions can be managed, said Dr Lishenga.
Meanwhile, Central Organisation of Trade Unions (Cotu) Secretary-general Francis Atwoli has defended the Social Health Authority (SHA) and urged Kenyans to be tolerant as the government resolves teething problems involving the health insurance scheme.
Mr Atwoli said he sits on the board representing workers and is aware on the benefits that Kenyans will accrue once current issues surrounding the scheme terming those opposing it as biggest beneficiaries of the defunct National Health Insurance Fund (NHIF).
“Being a representative of workers in the board, I cannot allow SHI funds to be mismanaged, and if it happens I will resign—of which I know it won’t happen. What I am asking Kenyans to give time to the board to address few issues to make the scheme workable,” said the SG.
“I was the person who initiated the removal of SHA chief executive officer Elijah Wachira since I suspected fishy deals were bedevilling him,” he added.
While addressing media in Kilifi, Mr Atwoli said SHI would have many benefits including in private hospitals unlike NHIF which only used to pay for beds whenever one is admitted.
Mr Atwoli also said some of those who are campaigning against the scheme own briefcase hospitals and they feel they have no room to mint Kenyan funds due to stringent measures put in place to protect the funds.
“We have had issues with NHIF but in this scheme, measures put to protect funds are per the Act of parliament and there will be no room for diverting money to other projects,” said the SG.
Mr Atwoli also asked church leaders to advise the government rather than criticising it and urge their followers to support the scheme since they are also beneficiaries of it considering hundreds of faith-based hospitals are covered.
“On Thursday we saw clerics criticising the government. But we urge them to be tolerant and urge their followers to support the scheme. We are not opposing criticism, but I will support church leadership if they point out corruption cases; not in the SHI which will benefit Kenyans,” he said.
On taxation, Mr Atwoli remained optimistic that taxes collected from Kenyans will benefit them.
“There's no country which can prosper without taxation. Most developing countries charge more than half of salaries and it works for them,” he said.
Additional reporting by Antony Kitimo
