A Nakuru-based surgeon on Tuesday painted a grave situation of hundreds of patients who cannot access health services in the chaotic transition from the National Health Insurance Fund (NHIF) to the Social Health Authority (SHA).
Making his submissions online while in hospital, Dr Magare-Gikenyi told Justice Bahati Mwamuye that he was attending to a stage 1 cancer patient who could not undergo surgery because there was no pre-authorisation yet the patient had paid his NHIF contributions.
The medic said it was unfair that while civil servants and members of the Kenya Medical Practitioners, Pharmacists and Dentists' Union (KMPDU) like himself had secured an extension to continue enjoying NHIF cover, the ordinary Kenyans have been left on their own.
“There are many cases, my lord. I am a civil servant and I and other members of the union (KMPDU) are enjoying NHIF services until November 30 because we made noise. What happens to other Kenyans who cannot make noise? What we are asking is not anything out of the ordinary,” Dr Magare-Gikenyi submitted as he asked the court to halt the roll out of SHA, pending the determination of the petition he and two others have filed.
Dr Magare Gikenyi, a consultant Trauma and General Surgeon.
Photo credit: Francis Mureithi| Nation Media Group
But as he made the submissions, the Ministry of Health defended the roll-out saying the problem causing delays was money and not the SHA system.
Through senior counsel Kioko Kilukumi, the ministry said Sh4.5 billion will be paid to health providers, to ensure services are not interrupted and patients access healthcare.
The lawyer said the system in use is working perfectly and that members who have been registered are receiving services.
Mr Kilukumi said at the close of business on October 28, 2024, a total of 13,338,143 Kenyans had been registered with SHA.
He added that 7,563 health service providers have been on-boarded in the system, making 96.1 percent of facilities with active licenses to offer services.
The ministry added that 88,244 claims amounting to Sh1.4 billion have been made in the SHA system while 38,200 pre-authorisations have been made and of this, 93.95 percent of the claims have been finalised.
Mr Kilukumi added that 114,034 total authorisations have been made by 3,023 health facilities.
“From the dash board kept by SHA, the digital platform does not have any problem. The problem lies with the finances, and which continue to be made available so that citizens can access healthcare,” he said.
Mr Kilukumi pleaded with the court to speed the hearing of the petition so that the matter can be concluded in the shortest possible time.
The case will be heard on November 22 as the judge ruled that he will determine the main case as opposed to interim applications.
Dr Gikenyi together with Busia senator Okiya Omtatah and Eliud Matindi have challenged SHA arguing that patients who were insured under the NHIF are experiencing untold hardship, including financial ruin, being unable to access services, and some have even died, due to the unreasonable disabling of the NHIF system during the transition period.
Mr Omtatah said to ensure seamless transition, the NHIF system ought to have continued running as the SHIF system was being set up.
“Ideally, since the project contract clearly stipulates that it will take the so-called Safaricom Consortium two years to develop their system, the rollover from NHIF to Consortium’s system should only be made after the lapse of the two years, on August 8, 2026, and only when the system has been tested and commissioned,” he submitted.
On its part, Safaricom has defended the special permitted procurement method used to award it the platform for the roll-out of SHIF at a cost of Sh104.8 billion.
The telco said the specially Permitted Procurement is one of the recognised methods of procurement in Kenya and that the same is provided for under section 114 (A) of the PPAD Act, 2015, especially where strategic partnership sourcing is required, such as in the present case.
Safaricom further said there was no obligation imposed on a procuring entity to publish tenders when Specially Permitted Procurement method is employed.
The company has opposed the issuance of conservatory order saying it would be against public interest as it would throw the public health sector into disarray and frustrate the statutory intent of the SHIF Act.
“The Integrated Healthcare Information Technology System for Universal Health Care provided by the Safaricom Consortium is critical to the operation of the SHIF, and therefore, it is in the best interest of the public that no conservatory orders are issued against the implementation of the contract,” Safaricom said.
