The Social Health Authority building in Nairobi.
Pleas for more time to fine-tune systems, postponement of the roll-out date twice, last-minute leadership changes and the abrupt disenabling of a scheme operational for nearly six decades, are some of the ignored red flags that have birthed the chaos in the government’s new health plan.
A day after the government suspended Mr Elijah Wachira as the chief executive officer of the Social Health Authority (SHA), which manages three major funds, including the Social Health Insurance Fund (SHIF), multiple interviews have exposed the series of missteps that ultimately led to the messy roll-out of the new system that has caused patients untold suffering.
And the emerging concern is that President William Ruto’s administration was in such a hurry to tap into the billions raised from the 2.7 per cent deductions from the gross pay of all salaried workers and procure a Sh104.8 billion digital system still under development to replace the National Health Insurance Fund (NHIF) that it ignored all the tell-tale signs of imminent trouble.
On September 26, 2024, Endebess MP Robert Pukose, the National Assembly Health Committee chair, warned the government against the roll-out of SHIF, citing potential corruption, concerns about single-sourcing, lack of tender documents and insufficient public participation.
Dr Pukose cautioned against the hasty roll-out of the Sh104.8 billion Integrated Health Information Technology System, noting that it had failed test runs in Marsabit and Tharaka Nithi counties.
The chair was also curious as to why the ministry bypassed the existing NHIF IT system, noting that it had been functional, in favour of this new costly system.
“Why can’t they focus on enhancing the National Health Insurance Fund system to include every registered member?”
“It is not clear to us why the ministry is insistent on replacing a system that has been working. Instead, they should be focusing on enhancing the current NHIF system so that it can include all registered members,” Dr Pukose said.
Fraud
“The process appears flawed. This looks like a fraud in the making. We need full transparency before making any decisions,” the Endebess MP said then.
And while suggesting a gradual implementation of any new system as opposed to a total shutdown of the existing one, the health committee members called on the office of the Attorney General (AG) not to approve the Safaricom-led consortium contract.
Seme MP James Nyikal was sceptical about the need for a new IT system, given that the NHIF one was still operational.
“We need to understand why this new system is necessary and who will fund it,” Dr Nyikal said.
Kisumu Central MP Joshua Oron expressed fears over the lack of scrutiny in the ERP component of the agreement.
However, the MPs later gave the health plan the green light.
In a report to the Senate, the Delegated Legislation Committee chaired by Tharaka-Nithi Senator Mwenda Gataya recommended that the Social Health Insurance (General) Regulations, 2024, and the Social Health Insurance (Tribunal Procedure) Regulations, 2024 be annulled for lack of public participation.
They cited that the two pieces of legislation were critical in the implementation of SHIF.
“The Ministry of Health was given enough time and opportunity to submit evidence of public participation, but that never happened,” the report says.
The roll-out of SHIF was initially set for April before being pushed to July 1, then again postponed to October 1 amid challenges with the digital platform designed to support contributions and registrations.
This postponement came a week after a transition committee on the Social Health Authority (SHA) warned in a report that the ICT system wasn’t ready for the big shift on July 1 as earlier gazetted by the then Health Cabinet Secretary Susan Nakhumicha.
Even by the time the government was rolling out on October 1, a number of structures had not been put in place, including numerous hospitals failing to log into the system.
In some hospitals, patients were turned away because their names were not on the SHA system and they did not have cash to pay for treatment. Most hit were terminally ill patients, including those undergoing chemotherapy and dialysis.
Healthcare providers were unsure about how they would be paid under SHA and the government’s failure to provide clarity created friction between service providers and the new system.
A week into its launch, numerous challenges, including system glitches, resistance by service providers and public confusion marred the transition.
SHA, which replaced the National Health Insurance Fund (NHIF), was supposed to provide better health services, broader access and greater efficiency, but its rocky start has been nothing but painful for patients and their families.
Legal challenges
The new healthcare system was marred by legal challenges, including court orders stopping its implementation which also raised concerns about the legitimacy of public participation.
The law that established SHA faced resistance from civil society groups, healthcare stakeholders, and even members of the public. The public participation process appeared rushed and insufficient, with many claiming they did not have adequate opportunity to weigh in on the reforms.
All these were signs that the implementation of the new health system would run into headwinds, but these concerns were largely downplayed.
Dr Vitalis Ogolla, dentist and a service provider under the former NHIF, said the Sh104 billion that the government was spending on a new ICT system introduced under SHA, was enough to build about six new referral hospitals across the country.
“This is enough to tell you that this project is for a few who are out to make money and not for the benefit of Kenyans. They should be ashamed,” Dr Ogolla said.
Questions have been raised as to why the cheaper option of Sh700 million upgrade of the existing NHIF ICT infrastructure wasn’t considered.
Dr Brian Lishenga, National Chairman of, the Rural Urban Private Hospitals Association of Kenya, told the Nation that prior to the transition, the association wrote a memorandum to the Ministry of Health proposing that the transition be done in two years.
Better preparation
The association gave extensive reasons as to why this would have made a difference and allowed better preparation and public sensitisation for hospitals to understand the shift and the digital investment they needed to make.
“We went as far as proposing a continuation of NHIF benefit packages as the new scheme is put in place. We requested for a sit-down to present this face-to-face, unfortunately for whatever reasons, our requests were ignored,” Dr Lishenga said.
He adds: “Had the government listened to various stakeholders’ proposals on the transition, the current mess would have been avoided.”
This month, the association did a survey and from the findings, over 75 per cent of private healthcare providers indicated that they do not have essential supplies, including cotton wool, gloves and painkillers. Almost 90 per cent are unable to meet their operational costs, including paying for their licenses and overheads like water and electricity. They also can’t pay their staff.
“The survey has shown that during the one-month transition, about 33 per cent of healthcare providers are facing auctions for various reasons,” he said.
In a candid assessment, he noted that if SHA were genuinely driven by lessons learned from the challenges and failures of NHIF, the new system could have ushered in an era of transparency, efficiency and inclusivity.
And the government has now shifted focus by ousting Mr Wachira. After just a month in office, Mr Wachira was removed on Tuesday evening, with officials citing his failure to address pressing issues.
SHA has seen significant leadership changes over the past two months. On September 17, President William Ruto appointed Dr Mohammed Abdi Mohammed as the new chairperson of the SHA board, replacing Dr Timothy Olweny, who had served since November 2023. On Tuesday, the SHA board suspended Mr Wachira and appointed Mr Robert Ingasira, the Director of Financial Services, in an acting capacity. The board blamed Mr Wachira for what they called a “chaotic transition”.
A source privy to the developments, who requested anonymity due to restrictions on speaking to the media, told Nation that Mr Wachira was under fire for bringing SHA operations under scrutiny.
SHA initiatives
The source further noted that Mr Wachira’s perceived lack of support for certain SHA initiatives had caused friction.
The source denied any knowledge of claims Mr Wachira had prioritised payments to private hospitals over public ones for services offered to SHA members.
Attempts to reach Mr Wachira for comment were unsuccessful, with one of his aides indicating he was not yet ready to speak, but would do so at a later time.
Dr Davji Atellah, Secretary-General of the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU), stated that the government pressed on with rolling out the system despite the union highlighting several critical issues that should have been addressed beforehand.
“Just two days before the official launch of SHA, the chairman of the Social Health Authority was replaced, disrupting leadership at a critical time. This late change raised concerns about the stability and preparedness of SHA’s governance structure. Such a significant reshuffle so close to launch should have been a warning sign about the readiness of the system and the internal challenges it faced,” Dr Atellah said.
“We asked for a meeting immediately this was gazetted so that we would work on the gaps. We opposed the implementation since it was going to disenfranchise civil servants and their dependants, in contravention of a 2011 collective bargaining agreement. No one listened to us,” said
“SHIF is a capsizing ship! There is too much bilge water for it to sail,” he added.
Kenya Union of Clinical Officers Secretary-General George Gibore said the government should have taken more time to look at the transition considering the financial constraints and even the infrastructure of most level 2, 3, and 4 hospitals.
“We were in a hurry to make money at the expense of Kenyans’ lives. Some of us requested for a sit-down and we were ignored,” said Mr Gibore.
