SHA system upgrade sees surgeries delayed
For about a week, the Social Health Authority (SHA) preauthorisation portal has been not been functional.
What you need to know:
- At a hospital in Kitale, employees reported more than 10 pending approvals dating back to late November.
- Most hospitals are reluctant to take on financial liabilities without assurance of reimbursement.
Patients requiring surgical procedures are now experiencing prolonged delays as hospitals across the country await crucial system upgrades before services can resume.
For about a week, the Social Health Authority (SHA) preauthorisation portal has been not been functional, leaving patients in need of critical surgical procedures in limbo.
The SHA preauthorisation portal was designed to streamline approvals for surgeries and other medical procedures, but the system has instead become a bottleneck. For the past week, there have been widespread delays in elective and emergency surgeries as the portal remained non-functional.
At a hospital in Kitale, employees reported more than 10 pending approvals dating back to late November.
“We’ve had to send patients back home, promising to schedule their surgeries once the approval comes through,” a hospital administrator told the Nation. “This delay has devastating consequences. Some of these cases require immediate intervention, but we cannot shoulder the cost without approval.”
In cases of emergencies, hospitals are now asking patients to pay cash up front.
“We’re left with no choice,” said another administrator. “Performing procedures without approval means we risk not being reimbursed. For now, cash payments are the only way to proceed with urgent cases.”
Dr Brian Lishenga, the national chairman of the Rural & Urban Private Hospitals Association, highlighted the widespread issues stemming from the recent updates to the portal. The changes introduced new rules, including requiring all preauthorisation requests to be verified by an auditor within the system.
“Previously, the preauthorisation process was seamless,” Dr Lishenga explained. “But it seems there was a flaw in the system when it was launched two months ago. Almost every procedure was being automatically approved. This led to a sharp surge in surgical bills, which have ballooned to nearly Sh5 billion in unpaid claims within less than a month. Concerns arose that this trend was financially unsustainable, prompting the adjustments.”
The newly introduced layers of verification require that every update be verified by a person. However, this has significantly slowed down approvals.
“Last week, hospitals from across the country raised concerns during our meeting. Both elective and emergency procedures are being affected,” Dr Lishenga said.
Elective surgeries, which are typically scheduled in advance, have been indefinitely delayed. Emergency cases are no better off, as hospitals are reluctant to take on financial liabilities without assurance of reimbursement.
“Over the weekend, we received a referral of a patient who had a serious accident and required surgery for fractures. The procedure should have been done yesterday, but without approval, the patient is left in excruciating pain. Unless we act purely out of mercy, there is nothing we can do, the patient will have to wait,” said an administrator.
“I have seven cases awaiting preauthorisation,” said a doctor who sought anonymity. “If I perform them without approval, then I will be left with the bill to clear. I still have some National Health Insurance Fund claims that were not settled after we performed the procedure. I learnt the hard way and will not repeat that mistake.”
According to Dr Lishenga, patients relying on private insurance face additional hurdles.
“Without SHA’s commitment to approve, their insurance cards remain inactive. This further complicates things for patients who thought they had a financial safety net,” he said.
He added that he had raised the issue with SHA Chairman Dr Ali Muhammed. He said that according to Dr Muhammed, doubts about the efficiency and accuracy of the preauthorisation department had led to a complete system overhaul.
“They suspect that some approvals were being given unnecessarily, which has caused the current freeze. Dr Muhammed assured me that this week would be spent fixing the system,” said Dr Lishenga.
But for patients like those waiting in Kitale and across the country, each passing day without the surgeries being carried out translates to unbearable suffering, unending queues, and mounting despair.
The crisis has revealed the fragility of the healthcare system, with vulnerable Kenyans bearing the brunt of bureaucratic inefficiency.
Efforts to reach Dr Muhammed were not successful as calls and messages to his known phone number went unanswered.
“At the onset of the SHA system, I encountered a significant challenge,” recounted Dr Ruto Cheregany.
“A patient came in with an ectopic pregnancy, a critical emergency. We rushed her straight to the theatre because waiting wasn’t an option. After the procedure, we submitted a request for approval but it was rejected. They demanded an ultrasound, which wasn’t feasible given the urgency of the situation.”
Dr Cheregany noted that such rigid requirements hinder emergency responses, leaving medical professionals in a difficult position.
“In cases like these, it becomes nearly impossible to prioritise life-saving procedures without prior approval. The only alternative is to ask patients to pay in cash upfront, which not all can afford,” he said.
Healthcare experts are urging immediate action to salvage SHA and prevent the total collapse of the healthcare financing system.
“We need SHA to clear the backlog of claims, fix the preauthorisation portal and implement transparent, efficient leadership,”Dr Lishenga said.
“While the authority’s vision was ambitious, its execution has left hospitals overburdened and patients abandoned in their greatest time of need. Unless drastic measures are taken, SHA risks becoming another symbol of unfulfilled promises in Kenya’s pursuit of equitable healthcare,” he added.
