The Kenyatta National Hospital in Nairobi, where 15 teachers received treatment under SHA.
Patients seeking specialised treatment at Kenyatta National Hospital (KNH) are facing sharply higher charges after the country’s largest public referral hospital quietly revised fees for several procedures in April.
The increases have left some patients unable to afford life-saving investigations, while others are paying cash because the procedures are not fully covered by the Social Health Authority (SHA).
The fee review, which took effect immediately, more than doubled the cost of some procedures and nearly tripled others. Patients interviewed by the Nation said they were not notified in advance and only learnt of the new rates when they arrived for scheduled appointments after travelling from different parts of the country.
The increases have also exposed gaps in SHA coverage, with many of the affected procedures either excluded from the scheme or covered only under specific benefit packages.
Among the procedures affected is colonoscopy, whose cost has risen from about Sh9,800, excluding biopsy charges, to Sh25,000. A biopsy now costs Sh2,500, bringing the total bill to Sh27,500.
Endoscopy charges have increased from Sh6,500 to Sh20,000, while patients requiring biopsies pay an additional Sh2,500, raising the total to Sh22,500.
The cost of an ultrasound scan has risen from Sh1,800 to Sh4,800, while the outpatient consultation fee has increased from Sh1,150 to Sh1,550.
Several patients told the Nation the increases had disrupted their treatment plans.
One woman, who requested anonymity to protect her family’s privacy, said she has been taking her husband to KNH for treatment of a chronic digestive illness for nearly a decade after other hospitals failed to manage his condition.
She said the latest increase has placed treatment beyond the family’s reach.
“The increase is killing my hope that my husband will receive treatment and eventually recover,” she said after paying Sh27,500 for his colonoscopy and biopsy at the hospital’s endoscopy unit.
She recalled that when they first sought treatment at KNH, the procedure cost about Sh6,000 before later rising to around Sh9,800. The latest revision has pushed the cost to more than four times the original amount.
Another patient from Nyeri County, who also declined to be named, said she was caught unaware when she reported for a scheduled review on April 24, the day the revised charges took effect.
She showed the Nation a mobile money payment confirmation indicating she paid Sh25,650 for the procedure.
“That is the day we were informed that the new medical rate card had taken effect,” she said.
A mother from Matuu in Machakos County said she struggled to raise the money needed for her son’s follow-up colonoscopy after surgery for a digestive condition.
She said the biopsy charge alone increased from Sh1,800 to Sh2,500 between appointments, pushing the total bill to Sh27,500.
“I struggled to raise it,” she said.
For some patients, the higher charges have meant postponing essential investigations altogether.
Stanley, a Kiambu resident, said he left the hospital without undergoing an endoscopy after discovering the revised charges.
He had been referred for the procedure because of persistent stomach pain.
“Because of the stomach pains I have been experiencing, I have been advised to undergo an endoscopy, but the price has gone up,” he said, adding that he returned home to look for money before rescheduling the procedure.
The entrance of the Accident and Emergency unit at Kenyatta National Hospital in Nairobi.
Another regular patient at the hospital said she missed a scheduled appointment on May 7 because she could not afford the new rates.
She said delays caused by equipment breakdowns have compounded the challenges facing patients.
“Some services are delayed because machines are unavailable or have broken down,” she said.
Patients also expressed frustration that SHA has not shielded them from the increased costs despite repeated assurances by the government that the scheme would reduce out-of-pocket medical expenses.
President William Ruto has consistently maintained that SHA is intended to eliminate financial barriers to healthcare, while Health Cabinet Secretary Aden Duale has said the scheme covers treatment in public hospitals.
However, patients interviewed by the Nation said they still had to pay cash for several specialised procedures.
A KNH doctor, who requested anonymity because they are not authorised to speak to the media, confirmed that many of the affected investigations are either not covered under SHA or are only reimbursed through limited benefit packages.
“Many patients assume SHA covers everything, but that is not the case. Colonoscopies, endoscopies and several specialised investigations are either not fully covered or are covered only under specific benefit packages. Patients are often shocked when they discover they have to pay cash,” the doctor said.
The medic attributed the fee increases partly to rising operational costs, including imported medical consumables, laboratory reagents and maintenance of specialised equipment.
According to the doctor, hospitals face difficulties sustaining specialised services when reimbursement does not match the actual cost of providing care.
The doctor urged SHA to expand its benefits package to include essential diagnostic procedures.
“Our appeal is that SHA should review its benefits package to accommodate these essential procedures. Many gastrointestinal diseases are detected through colonoscopy and endoscopy. If patients cannot afford these procedures, diagnosis is delayed and treatment becomes even more expensive. Covering these investigations under SHA would save many lives in the long run,” the doctor said.
The Nation sought comment from KNH management on the revised charges and concerns raised by patients.
Calls to Chief Executive Officer Dr Richard Lesiyampe at 3.28pm and 3.43pm, and Deputy Chief Executive Officer Dr John Ngigi at 3.59pm went unanswered. Text messages sent to Dr Lesiyampe at 3.47pm and Dr Ngigi at 4.04pm also did not receive a response by the time of publication.
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