Patient Service Access Survey Reveals Major Challenges in Social Health Authority Rollout in Selected Counties in Kenya.

 A new survey from the Caucus of Patient-Led Organizations of Non-Communicable Diseases (NCDs) has highlighted significant obstacles in Kenya’s Social Health Authority (SHA) rollout, impacting patient access to essential healthcare services. Conducted in October 2024 across hospitals in Nairobi, Kiambu, Meru, and Bomet counties, the survey identified critical barriers for patients with chronic conditions who now struggle to receive timely, affordable care.

Among the issues highlighted were severe access delays and system inefficiencies at public hospitals. For example, facilities like Kenyatta National Hospital and Kenyatta University Referral Hospital reported that patients often face hours-long waits due to frequent system malfunctions. These technical failures hinder access to diagnostic imaging and specialized procedures, amplifying patient distress. In private hospitals, SHA coverage is limited, with only civil servants in certain job groups eligible for Social Health Insurance Fund (SHIF) benefits, leaving many NCD patients, including cancer patients and transplant recipients, without coverage. Mission hospitals, such as Tenwek, provide no SHIF coverage, limiting access to specialized care for rural populations.

Patients have also faced increased out-of-pocket expenses for outpatient and drug refill services, previously covered under Kenya’s National Health Insurance Fund (NHIF). Additionally, unresolved NHIF debts and a lack of clear SHA benefit guidelines make healthcare providers wary of offering services, fearing delayed reimbursements. The suspension of overseas treatment coverage has further complicated matters, leaving patients in need of specialized procedures not available in Kenya without options.

“Many patients lack information on SHA benefits, premium structures, and eligibility,” the survey notes. This lack of public awareness leaves patients unprepared for the SHA’s new terms and services.

 

According to Evans M. Majau, Chair of the Caucus of Patient-Led Organizations of NCDs, these findings expose major weaknesses in SHA's ability to serve Kenya’s patients effectively, especially those with chronic and complex conditions. “The survey findings reveal critical gaps in SHA’s ability to serve Kenyan patients effectively, especially those facing chronic and complex conditions like cancer, diabetes, and cardiovascular diseases,” he said. “The SHA rollout must prioritize transparency, access to specialized care, and patient inclusion to fulfill the promise of universal health coverage in Kenya. We urge the Ministry of Health and SHA leaders to engage with patient voices and take swift, corrective action to address these issues.”

The Caucus has issued several recommendations, including resuming SHIF coverage for overseas treatments, clarifying SHA benefit structures, addressing system failures to reduce waiting times, settling NHIF debts, and increasing public awareness of SHA services. “Through collaboration and informed action,” Majau emphasized, “we can work toward an equitable healthcare system that guarantees timely, quality care for every patient.” The Caucus remains committed to advocating for the health needs of all Kenyans, striving for a healthcare system that meets the needs of every patient, especially those most vulnerable.