Patients are grappling with a compounded healthcare crisis as the rollout of the new Social Health Insurance Fund (SHIF) continues to faces major hurdles.
A growing number of service providers, including dialysis centres, and private hospitals threatened not to on-board the new system, citing unpaid debts and unresolved issues from the defunct National Health Insurance Fund (NHIF).
The transition to the Social Health Authority (SHA) was intended to streamline healthcare services, but the reality on the ground tells a different story.
With NHIF owing dialysis service providers more than Sh10 billion, many hospitals are refusing to join SHA until their outstanding payments are settled.
This delay is already affecting the availability of essential services, leaving patients stranded and unable to access critical treatments, with kidney and cancer patients being the recent most affected group.
Already, dialysis providers have indicated that they will only transition to SHA after their outstanding payments of Sh10 billion are settled.
The providers indicated that after providing services to kidney patients across the country, the NHIF, which has since ceased working, has failed to reimburse their dues.
Additionally, they have said that the current rates being proposed by SHA do not align with market conditions, leaving many service providers drowning in debt.
Frustrated by NHIF's inability to fully remit claims, dialysis providers are now refusing to transition to the new system.
“We have worked closely with NHIF for over two decades to provide quality health care for patients with kidney disease, however, we are deeply concerned by the NHIF's failure to readjust the reimbursement rate to match the market condition and to fully remit claims,” says Dr Jonathan Wala, chairman, Kenya Renan Association.
He adds: “This financial shortfall has forced several dialysis units to shut down, undoing much of the progress made. The now-defunct NHIF owes dialysis providers more than Sh10 billion with no formal mechanism in place to address the crippling debt.”
With the rollout of SHIF, the association indicated that they had hoped for improvement in service delivery and the establishment of a clear and transparent framework for reimbursement but this is not forthcoming.
“We have submitted several recommendations to SHA to address critical gaps in kidney health services but nothing is forthcoming, instead we have since witnessed a chaotic roll with patients being turned away from hospitals,” he said.
“Our patients are currently facing life-threatening uncertainty due to the disorganized SHA rollout, many making out-of-pocket payments, missing sessions, non-citizens not allowed to register with new patients unable to access treatment,”
He said providers have not signed a formal contract with SHA as dictated by the regulations: “The promised digital contract system is yet to be implemented, leaving providers uncertain about their legal standing.”
The association has, therefore, called upon the government to come up with a formal contract with the service providers without delay. Also, the provision of clear and consistent guidelines for patients and providers to ensure uninterrupted service delivery.
“SHA must implement our previous recommendation to improve kidney health coverage in the country including extending dialysis cover to three sessions and expanding transplant services,” says the statement.
The problem with dialysis is not just the interruption of services but even if the services were in place, the sessions have been reduced and the allocation reduced from Sh9,500 to Sh2,375, according to the new proposal benefits.
Hospitals are now sending messages to patients on clinic days to come up with an additional sum of Sh7,000 in cash to top up for their dialysis sessions.
Dialysis is a life-saving procedure, and without timely treatment, many patients could suffer serious health complications or even death.
“This situation is unacceptable. Patients should not be the ones to suffer because of bureaucratic delays and inefficiencies,” said a healthcare advocate.
As the standoff continues, Kenya’s dialysis patients face uncertainty, with the risk of reduced access to the vital care they depend on growing by the day.
But Medical Services Principal Secretary Harry Kimtai said renal and oncology centres had agreed to provide care.
"Currently, 232 out of 353 renal and oncology providers have committed to delivering services under SHA, and this list will be published online today (Friday October 4). Pre-authorization is not required for former NHIF members who need renal or oncology care, as they have transitioned to SHA," Mr Kimtai explained in a statement on Friday, October 4, 2024.
On maternal care, Under NHIF, the Linda Mama programme provided coverage for antenatal, delivery, and postnatal services, with reimbursement rates between Sh2,500 and Sh5,000 for normal deliveries in government hospitals, and Sh3,500 to Sh17,000 for private and faith-based facilities.
SHIF is likely to fail mothers and babies in this country, it will only offer Sh10,000 for normal deliveries and Sh34,200 for C-sections which is way less than and restrictive. Many who will get services above the amount will be forced to dig deeper into their pockets.
Cancer patients on the other hand will find much-needed support through SHIF, which offers expanded coverage for oncology services. Under the new system, up to Sh400,000 will be available for cancer treatments, including surgery, chemotherapy, radiotherapy, hormone therapy, and immunotherapy.
These services will be available for the most common cancers in Kenya, including breast, prostate, colorectal, cervical, and childhood cancers. Both screening and treatment will be covered, promoting early detection and better outcomes for cancer patients.
However, even with the availability of the services, the Kenyan Network of Cancer Organizations (KENCO) has warned that despite assurances that the process would not be seamless—particularly for vital services such as dialysis and cancer care, patients are being denied services or asked to pay out-of-pocket for their cancer treatment with many patients leaving without receiving care.
“This disruption leaves cancer patients, many of whom rely on insurance for their treatment exposed to disease progression, which can have severe consequences. This is unacceptable. We call on the government to urgently implement measures to ensure that patients can continue accessing services at their preferred facilities without interruption,” says their statement.
Already, the newly implemented SHA is facing a series of significant problems, stirring public frustration and backlash across the country.
One of the most glaring issues is the increased financial burden on Kenyans. Under the now-defunct NHIF, the maximum contribution was capped at Sh1,700.
However, with SHA, individuals are now required to contribute 2.75 per cent of their household income, a steep rise that is squeezing already strained finances.
A number of them have yet to receive a formal contract to get into the system. The system has been down since the registration started on Monday this week.
Many facilities have reported that they cannot access the platform, leaving them unable to process claims or register patients effectively. Worse still, patients who have registered with SHA are discovering that their names are missing from the system, preventing them from receiving the services they need.
Mr Kimtai, the Medical Services Principal Secretary, however, said the system was open and all had been on-boarded.
"We are pleased to confirm that the SHA claims system is now fully functional. Training for health facilities on the claim portal has begun and will continue throughout the week," said Mr Kimtai.
He insisted that the SHA system is fully operational, with ongoing training for healthcare facilities on how to use the claims portal.
The cost of implementing the SHA system has also come under sharp criticism. The system will reportedly cost taxpayers a staggering Sh104 billion to develop and implement, an amount significantly higher than the Sh700 million it would have cost had the government opted to upgrade the existing NHIF ICT infrastructure.
This enormous difference has raised questions about the decision-making process and transparency behind the SHA’s rollout forcing the Members of Parliament to question why a new health information system costs billions adding that the Integrated Healthcare Information Technology System (IHITS) was rushed and lacked adequate public participation.
“All previous contributions to NHIF would be transferred to SHA. A means-testing instrument integrated into the system will determine the contributions of non-salaried members.
"To protect patients' data, the National Health Information Exchange (NHIE), overseen by the Digital Health Agency, will ensure secure management of sensitive information. This will be done in compliance with Section 47 of the Social Health Insurance Fund (SHIF) and the Data Protection Act No. 24 of 2019, guaranteeing patient consent and privacy," he added.
For patients and healthcare providers alike, the transition from NHIF to SHA has been chaotic.
Many Kenyans feel they are paying more for a system that is not yet fully operational, leading to widespread confusion and anxiety about how long it will take for the new scheme to function effectively.
As service providers continue to struggle with onboarding issues and system failures, the success of SHA hangs in the balance, with both hospitals and patients bearing the brunt of these early challenges.
"All public health facilities and 1,577 private and faith-based facilities have signed contracts with SHA. During this transition period, no health facility is permitted to deny services to patients," the Principal Secretary concluded.
