Chaos! A story does not often start here, but what else can describe what has happened in the past few days since the healthcare services were fully transitioned into a new social health scheme?
When the clock struck midnight on September 30, the National Health Insurance Fund (NHIF), a lifeline for millions of Kenyans over the past 58 years, ceased to exist. In its place, the Social Health Authority (SHA) took charge, ushering in a new and uncertain era in healthcare.
For decades, NHIF was the only form of health insurance for many Kenyans, particularly those unable to access private insurance.
But the sudden shift from NHIF to SHA has left patients, healthcare providers and hospitals grappling with numerous unanswered questions as they navigate the new system, raising questions about the future of healthcare in Kenya.
According to the World Health Organization (WHO) and the 2022 Kenya Demographic Health Survey, only one in four Kenyans has health insurance coverage, with more than 84 per cent relying on the now defunct NHIF.
Health insurance in the country is deeply linked to income, with coverage rising sharply with wealth: only five per cent of low-income earners have insurance compared to 56 per cent of high-income females and 60 per cent of high-income males.
The coverage remains alarmingly low compared to other nations. At three per cent, Kenya has the third lowest insurance penetration in Sub-Saharan Africa, with South Africa leading at 17 per cent, notes WHO.
However, even with many Kenyans relying on NHIF, the long, winding road of the scheme is a tale woven with threads of multiple scandals, including misappropriation of funds, limited reach and inefficiency. By the time of its dissolution, hospitals were left in the lurch and owed more than Sh20 billion, while fraudsters and corrupt officials siphoned resources, leaving the system teetering on the brink of collapse.
For some Kenyans, its folding was a welcome relief — good riddance to a sinking ship. But for others, the looming question as a new social health scheme was being rolled out remained: Would this be a case of the same script, just a different cast?
This transition is not just administrative—it has direct consequences for patients, hospitals, and health workers alike. With more than half of the population still uninsured, the effectiveness of SHA will soon be put to the test as it seeks to address the nation’s healthcare challenges.
Under the SHA, three distinct funds now manage the nation’s health needs: the Primary Healthcare Fund, the Social Health Insurance Fund (SHIF), and the Emergency and Chronic Illness Fund.
Of these, individuals are expected to contribute 2.75 per cent of their household income to the SHIF, while the government is responsible for funding the other two.
For the week that the system has been in place, many patients, more so those with chronic illnesses, have missed their critical treatment and appointments.
This delay has left both doctors and patients in a state of limbo, with healthcare professionals growing increasingly concerned about the long-term impact on patients’ health.
The uncertainty is creating a backlog of untreated cases.
Broken healthcare system
On the eve of October 1, the first day under SHA’s management, Sarah Kimani’s father, a resident of Nairobi, received a text from his regular clinic. The message was clear yet unsettling: he needed to bring Sh7,000 in cash for his upcoming dialysis session as the usual cover would now only handle Sh2,375.
“That was the cue that we were in for a rough day ahead. Ordinarily, my father, who has high blood pressure, is diabetic and hypertensive, doesn’t need someone to accompany him for his weekly dialysis sessions. But with this new development, I took the day off work and went with him in the morning. When we arrived at the clinic, they initially refused to offer the services, claiming that even previous sessions, which had already been provided, hadn’t been approved,” she says.
Outside the Margaret Kenyatta Mother-Baby Wing at Nakuru County Referral and Teaching Hospital, Anna Cheptonui stood with her arms wrapped around herself, eyes red from sleepless nights and tears.
In one of the beds at the ward, her 18-year-old daughter had given birth to a girl two days ago. But there was no joy, no celebration for the life brought into the world. Instead, she was trapped in despair.
Anna had journeyed from Mau Narok clutching the promise of the Linda Mama programme—the government’s free maternity service—as their only hope. But now, three days later, that hope was fading.
She couldn’t take her daughter and grandchild home because she couldn’t afford the Sh7,500 hospital bill, a fee she hadn’t anticipated.
Upon delivery and awaiting discharge, she was informed that the programme had been disabled. Further, the maternity benefits package, supposed to cover maternity services and ease the financial burden for families like hers, had yet to be activated. A series of administrative glitches left Anna, her daughter, and her granddaughter in limbo, with no coverage and no way to pay the fees.
Hospital staff
The hospital staff, sympathetic but firm, explained that the trio couldn’t be discharged without settling the bill.
“I sleep and wake up here. I don’t even have money for food or the hospital bill. I will continue staying here until a solution is found,” she said.
But the healthcare workers, too, were caught in the bureaucratic mess, unable to process claims from the new healthcare plan because of delays in its implementation.
What was meant to be a smooth transition safeguarding the health of mothers and their babies had instead left families like Anna’s stranded in uncertainty.
“I feel like I’m being punished for something beyond my control. I did everything I was supposed to. I paid my premiums, followed the rules, and now I’m stuck here,” she lamented.
SHA, the new healthcare system that promised to ease suffering, had instead compounded it, leaving Anna and countless other mothers in more profound distress.
The trio was finally allowed to leave for their Mau Narok home on Thursday, a day after Nation. Africa and NTV highlighted their plight.
Isaac Ochieng, a resident of Nakuru County, grappled with confusion and frustrations after he was forced to pay for services in cash. His wife gave birth late at night on September 30, and when he went to pick her up the following morning, he was informed that maternity services were no longer accessible.
“I’ve always trusted Linda Mama to cover the costs. But when I arrived, they told me the service had been disabled. They asked me to register under SHA, but no confirmation came through,” Isaac said.
Martin Macharia, whose wife underwent a cesarean section, also faced the brunt of the sudden transition. He was shocked to be handed a bill of Sh17,000 despite being previously assured that NHIF would cover the costs. A visibly distressed Martin threatened to report the matter to the police.
“Where am I supposed to get Sh17,000 from? I am a small-scale farmer. Even if I borrow money, I can’t sell anything to raise that amount.”
The problem is not limited to maternity care.
Rose Maina, also a resident in Nakuru County and whose husband requires regular dialysis, was told she had to pay more than Sh4,500 for his treatment—something that NHIF once covered.
Even patients seeking more straightforward treatments have been caught in the bureaucratic tangle.
Mushono Kimani, who visited Nakuru Level 5 Hospital for wound dressing, was told to pay out of pocket after being informed that SHA was not operational.
“We used to pay through NHIF, but now they’re saying we must pay cash. SHA isn’t working,” Mushono lamented.
The hospital’s administrator, James Waweru, confirmed that the hospital is facing significant technical challenges with the SHA system.
“At the moment, there is no functional system in place,” James said. He added that, according to SHA guidelines, only patients referred from Level 4 facilities are not required to pay to access treatment.
Veronica Mwangi, the founder of the Lady Hope Wellness Institute in Nairobi County, said the past few days have been tough for her and the cancer patients she supports through the organisation.
“I’m drained,” she admitted.
“I’ve been getting heart-breaking messages from patients… patients who are supposed to be getting help but aren’t. Just recently, one of the women I have been supporting couldn’t go through with her chemotherapy. It was supposed to be her fourth session out of six, but it never happened because of issues with SHA invoicing. She’s fighting for her life and stuck waiting on paperwork.”
These are just a sample of frustrating encounters from thousands of Kenyans caught in the confusion and chaos of the government’s recent transition from the NHIF to SHA, a healthcare reform designed to expand coverage and improve efficiency. While the transition was hailed as a game-changer for the country’s healthcare system, its rollout has been anything but smooth.
From major cities and towns to Kenya’s most remote regions, patients, doctors, and administrators alike have been grappling with a myriad of problems—unprocessed claims, missing records, crippled systems and a complete breakdown in communication between hospitals and government offices.
Thousands of patients were being turned away from hospitals, forced to beg for the care they so desperately needed or pay out of pocket. If you didn’t have cash in hand, you were out of luck—damned and left to suffer in a system that seemed to favour those who could afford to pay.
In sheer frustration and despair, some begged the SHA management for help as they struggled to access the much-promised universal health coverage for all.
“When gospel deejay, DJ Krowbar, posted on X about the predicament of getting dialysis services for his wife, I responded and told him what the clinic had said, and an official from SHA saw my reply and sent me the circular that they had shared with health facilities across the country,” offers Sarah.
The memo required health facilities to serve patients with chronic or critical illnesses.
“Upon reaching the clinic, we were told to top up. I informed him about it, and he denied that such a thing could happen. I sent him the bill, and he called the facility and instructed it to offer him the service,” she offers.
According to Sarah, the official acknowledged they were having issues transitioning into the new system. “He admitted that there are mistakes, but they are requesting hospitals to continue offering services as the mess is being sorted,” she added.
As the country navigates this significant shift, many ask: Was Kenya ready for this transition?
A few days before the planned rollout, acting SHA CEO Elijah Wachira told Healthy Nation that NHIF would cease to exist on September 30 and that any patient requiring treatment starting October 1 would be treated under the new social health scheme.
Those in informal employment or without a stable monthly income must pay their health insurance premiums as a one-off lump sum. For example, suppose the means testing tool determines your premium is Sh300 per month. In that case, you’ll need to multiply that by 12, paying Sh3,600 upfront before accessing treatment from contracted health providers.
Before the rollout was postponed to October 1, the original plan was for Kenyans to be onboarded to SHA in July. For patients who require weekly dialysis, many rushed to register, hoping for a seamless transition. Instead, this is when their problems began.
John Gikonyo, president of the Renal Society of Kenya, explains that the premiums amounted to a hefty Sh20,650 when they registered back then. “We have a WhatsApp group, and dozens of us were given the same figure. Remember, many are not in formal employment and were required to pay upfront,” he says. The questionnaire used to calculate the premiums included many questions—such as the level of education, the type of house one lived in, the number of toilets, and whether they were connected to a sewer line or a septic tank.
“I reached out to SHA management then, and they admitted that there were problems with the system and were working to improve it. When the registration plans started again, many registered and got different figures. I am yet to know how much I will be required to remit,” he offers.
This past week, Mr Gikonyo’s phone was flooded with messages from members of a WhatsApp group, including all renal patients and their families. Many were being told they wouldn’t receive dialysis on the first day of rollout if they didn’t pay for the service in cash. “I had to gather all the complaints and send them to SHA management, who then contacted the specific hospitals,” he explains. “But despite that, some patients have still been forced to pay in cash just to receive treatment.”
Sarah posed the question, “If I didn’t know the official, and many Kenyans don’t know anyone they can call from SHA, what would have happened to my 81-year-old father or what could have happened to them or their loved ones? So, to receive healthcare services we are paying so much for, must we pull strings from government officials?”
When Healthy Nation followed up with Sarah regarding her father’s next dialysis session, the family was back to square one. “We received a text on Thursday evening informing us that the facility would only accept cash payments,” she said.
In October 2023, President Ruto signed the Universal Health Coverage bills into law to rekindle the Universal Health Coverage (UHC) dream and establish the three funds. To ensure a smooth operationalisation, the government, through the Primary Healthcare Act 2023, provides for the construction of community health units so patients can access primary healthcare services at the grassroots levels.
Amid persistent concerns about the readiness of its rollout, and as services gradually resume in some facilities, questions continue to arise regarding the necessity of transitioning from the NHIF system. Meanwhile, the acting SHA CEO has directed hospitals to continue using the NHIF system until the new SHA system is fully implemented.
Source link : https://nation.africa/kenya/health/shif-cure-for-ailing-heathcare-system-or-a-repeat-of-past-mistakes–4786224
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Publish date : 2024-10-07 03:00:00
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