A parliamentary committee has identified structural foundation issues, gross underfunding and delayed, unpredictable reimbursements to health facilities as core bottlenecks for cancer patients within the Social Health Authority (SHA).
In considering a petition by the Kenya Network of Cancer Organisations (KENCO), the National Assembly Health Committee has identified at least nine issues with the SHA that it wants the Ministry of Health to address to ensure patients have access to quality healthcare.
In its report, the committee pointed out that the combined household benefit of Sh550,000, comprising Sh400,000 under the Social Health Insurance Fund (SHIF) and Sh150,000 under the Emergency, Chronic and Critical Illness Fund (ECCIF), falls below the Sh600,000 individual annual cover previously available under NHIF.
National Assembly committee on Health chairperson and Seme MP James Nyikal.
Photo credit: Jared Nyataya | Nation Media Group
The James Nyikal-chaired committee also pointed out that the shift from individual to household-based coverage eliminates the flexibility that previously allowed spouses to supplement each other’s benefits.
The committee also says in its report that the structural foundations of SHA's cancer care financing are underfunded.
For instance, the committee noted that the Primary Health Care Fund, essential for cancer screening, prevention and early detection, received an allocation of Sh4.1 billion against an identified requirement of Sh61 billion, representing a funding gap of 93 percent.
“The direct cost of comprehensive treatment for this patient easily exceeds Sh3.8 million. This demonstrates beyond any doubt that the current SHA cancer cover of Sh550,000 per year is grossly insufficient to provide equitable access to care. Reducing the oncology package is not just a technical policy change. It is a life-and-death decision for thousands of Kenyans,” reads the report.
In addition, the committee said that the ECCIF, the safety net for patients who exhaust their SHIF benefit, was allocated only Sh2 billion against a requirement of Sh107 billion, translating to a shortfall of 98 percent.
According to the committee, the Emergency, Chronic and Critical Illness Fund (ECCIF), designed as the financial safety net for patients who exhaust their SHIF benefits, remains effectively inaccessible and almost entirely unknown to both patients and healthcare providers.
In consideration of the petition, the committee also noted that the annual payment of SHIF in full is prohibitive and punitive for cancer patients, especially those from low-income households.
The committee noted that the manner of revising the benefits package and tariffs under the social health insurance framework is cumbersome, lengthy, and not responsive when urgent policy changes are required.
According to the report, there is a severe and systemic information deficit affecting both cancer patients and health facilities in relation to benefit entitlements, the SHA financial year, and access procedures.
“The administrative procedures and digital systems of the Social Health Authority have created serious bottlenecks in the approval and delivery of cancer treatment, posing significant risks to patient health and survival due to disease progression,” reads the report.
The committee also criticised SHA's abrupt stoppage of services, saying the unilateral cessation of services adversely impacts the right to health guaranteed under Article 43 of the Constitution.
“Policy changes must be properly communicated with adequate advance notice and sufficient transitional safeguards for all patients, and in particular for cancer patients,” reads the report.
The committee now wants the Ministry of Health and the Social Health Authority to provide civic education on the benefits package and tariffs, focusing particularly on cancer care services. They must then report to Parliament within four months.
The committee has also called on the Cabinet Secretary for Health, Aden Duale, and the Social Health Authority (SHA) to urgently review the Tariffs for Healthcare Services, 2025 (Legal Notice No. 56 of 2025), to enhance oncology benefits to a minimum of Sh800,000.
