The Social Health Authority building, Nairobi in this picture taken on October 6, 2024.
On April 16, Michael Kinyanjui made what he thought would be a routine hospital visit. Accompanied by his wife, a cancer patient due for her chemotherapy session, the couple arrived early at Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu, hopeful for a smooth process under the new government health insurance scheme, the Social Health Authority (SHA).
Jaramogi Oginga Odinga Teaching and Referral Hospital.
Mr Kinyanjui, who is the principal holder of the SHA account, has registered his wife as a dependent. At the hospital, a deduction of Sh26,805 was made from his account for the oncology services.
“As the treatment was about to begin, we were informed that one of the chemotherapy drugs was out of stock. The hospital then referred us to Blue Ridge Health Clinic, a private facility, to source the missing drug,” Mr Kinyajui said.
At Blue Ridge Health Clinic, according to the transactions seen by the Nation, three pre-authorisations were lodged for the same transactions, which came at different times of the day, but the same amount.
“This has left me questioning the integrity of the SHA system because why would the deduction be done twice for the same procedure, and an OTP (one-time password) sent four times to two different people, and no explanation is given?” Mr Kinyanjui questioned.
He said he got notification of the first deduction of Sh25, 000 a few minutes after pre-authorisation and the claims were launched in the SHA portal. Six hours later, after he got home, he received another pre-authorisation request from Blue Ridge, again for Sh25,000.
“It was the same amount for the same drug I had already paid for earlier that day.”
The message, sent through the SHA portal, asked him to verify and consent to chemotherapy medicine services, accompanied by an OTP. Curiously, two different OTPS were sent to his phone. His wife also received two OTPs for the same request, raising further suspicion of a duplicate billing attempt. When he called Blue Ridge for clarification, the facility seemed unaware that any new authorisation had been made, adding to the growing confusion.
“You know what worries me, why would the deduction be done twice for the same procedure. OTP was sent to two different people four times, which means someone was seeking pre-authorisation. Probably, they used my documents, which I forgot to pick up after getting the drug,” he said.
Elderly persons register for the Social Health Authority (SHA) at Arujo Location Chiefs Camp in Homa Bay Town on March 5,2025.
“I left photocopies of all the receipts and authorisation requests at the facility. But to date, no one has given me a satisfactory explanation,” Mr Kinyanjui said, expressing frustration over the absence of a clear grievance redress system.
He has since reported the matter to the police. When he called the SHA customer care, he was told to report the complaint to the quality assurance officer at the Siaya County SHA office.
For Mr Kinyanjui, the issue is not just financial, it’s about trust.
“We’re told this system is supposed to protect us, to make healthcare affordable. But I’ve paid Sh50,000 in one day, under the same health scheme, for the same medication. If I wasn’t vigilant, another Sh25,000 would have been deducted without my knowledge,” he lamented.
This is not the only complaint about SHA that has been lodged by patients ever since it was launched. Many patients have been complaining of being forced to make out-of-pocket payments despite having an active SHA account with regular contributions.
“It is not that SHA is not working, they are getting our documentation, then later you are either told that the system is down and that we pay cash or that the drugs are not available, but later you get an OTP message,” said Ms Elizabeth Oduor. “What scares me is that there is no way one can tell the balance remaining on one's card. Can the government arrest this before we go the NHIF way?”
An official from SHA who is not mandated to speak to the media told Nation that the hospital needs to be investigated.
“This is suspicious. There is someone playing some tricks. In fact, even with the delays in the system, the OTP response should be once and not four times. It means, then, that the preauthorisation was done many times. This could be a fraud case,” the official said.
A call to the hospital went answered.
