Survey Reveals Significant Barriers in Social Health Authority Rollout in Kenya

 Survey Reveals Significant Barriers in Social Health Authority Rollout in Kenya

November 5, 2024 – Nairobi, Kenya By Brenda Asugu 

A recent survey by the Caucus of Patient-Led Organizations of Non-Communicable Diseases (NCDs) reveals major challenges in the rollout of Kenya's Social Health Authority (SHA) and Social Health Insurance Fund (SHIF), with thousands of patients, particularly those with chronic conditions, struggling to access affordable, timely healthcare.

 

PHOTO: The NDSs  chairperson Mike Gikonyo together with collegues addressing the media

The survey, conducted between October 24 and October 25, covered public, private, and mission hospitals across Nairobi, Kiambu, Meru, and Bomet counties.

According to Dr Gikonyo the NCD he said they are working towards equitable ways to engage with patients. He also added that survey findings concluded that  non communicable disease such as cancer diabetes and cardiovascular diseases have a critical gap.

"If they're not able to access treatment and care. It is going to have a severe impact one on quality of life and possibly lead to premature death" .

The findings highlight a range of issues impacting patients' ability to obtain critical healthcare services Access Delays and Systemic Inefficiencies Public hospitals, including Kenyatta National Hospital and Kenyatta University Referral Hospital, reported frequent delays and technical failures within the SHA system. These issues leave patients waiting for hours, sometimes days, to access essential services such as diagnostic imaging and specialized treatments. Technical "system hangs" were cited as a common cause of these delays, worsening the already challenging experience for many patients.

Limited SHA Coverage in Private Facilities, many private hospitals, such as Nairobi Hospital and Ruaraka Family Hospital, have limited SHIF coverage to specific job groups, primarily civil servants, excluding a large portion of NCD patients. This restriction has been especially challenging for cancer patients, transplant recipients, and other high-risk groups, who now face increased out-of-pocket costs for services that were previously covered by the National Health Insurance Fund (NHIF).

Some barriers to Specialized Care include. In mission hospitals like Tenwek Hospital, there is no SHIF coverage at all, creating significant access gaps for rural patients who need specialized care. In addition, public facilities such as Mama Lucy Kibaki and Mbagathi hospitals have reported an inability to perform advanced procedures, like cardiac surgeries, for SHA patients, severely limiting treatment options for NCD patients requiring life-saving interventions.

Broader Challenges Affecting All Facilities  Outpatient and Drug Refill Costs-Patients now must pay out of pocket for basic outpatient services and medication refills burden previously eased by NHIF. This shift has added financial strain, limiting access to primary healthcare for many NCD patients.

Unresolved NHIF Debts and Unclear SHA Benefits - Healthcare providers report concerns about outstanding NHIF debts and lack of clarity regarding SHA benefit structures. This uncertainty makes some healthcare providers reluctant to offer services, fearing delayed payments or exclusions under the new system.

No Overseas Treatment Coverage -  SHA currently excludes coverage for overseas treatments, an essential need for patients requiring specialized care not available within Kenya. This suspension leaves many without options for critical treatments.

Lack of Public Awareness - The survey also highlights a lack of public understanding of SHA benefits, premium structures, and eligibility requirements. Many patients are unaware of the SHA's offerings and remain unprepared to navigate the new system.

The Caucus of Patient-Led Organizations of NCDs has called for immediate improvements to the SHA and SHIF systems to ensure that all Kenyans, particularly those with chronic health needs, can access the care they need. Addressing technical inefficiencies, expanding coverage, and increasing public awareness are critical steps to make the SHA rollout successful.

As Kenya grapples with the burden of NCDs, these issues underscore the urgency of implementing a health system that serves all citizens equitably, ensuring access to necessary treatments without the added strain of financial hardship.

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