How SHA came through for miner with broken collarbone

Livingstone Mukoya recuperates after surgery on his broken collar bone at St Elizabeth Hospital, Mukumu, in Kakamega. [Alexander Chagema, Standard]

For four days, Livingston Mukoya, 25, endured pain from a broken collar bone in the surgical ward at St Elizabeth Hospital, Mukumu in Kakamega County.

He sustained the injury after a huge rock fell on him while prospecting for gold inside a gold mine in Lirhembe, Kakamega County on December 23, 2024.

He was admitted to  St Elizabeth Hospital, Mukumu on the same day where he was examined and recommended that he be fitted with an intramedullary rod (what ordinarily is known as chuma) to help the broken bones mend. However, he had not yet registered with the Social Health Authority (SHA) 

“At the time of the accident I had not yet registered with SHA. So, when I was brought here, I was asked to pay a whole year’s subscription, Sh5,400 before receiving the medical attention that I required, which I did,” Mukoya says. 

The doctor told him he needed to have an intramedullary rod fitted, but the hospital could not proceed with the surgery without authorisation from SHA. 

In a communication dated December 26, 2024 between Mukumu Hospital and the SHA office that The Standard team saw, the cost of the surgical procedure, including the intramedullary rod  amounts to Sh145,600. 

“I got worried that even after making the payment, the surgery had not been done several days later. All I had been getting since admission were painkillers,” Mukoya said shortly before surgery. 

Like many other people who don’t understand how the medical scheme operates, Mukoya blamed  it on SHA, which has been receiving a lot of negative publicity.

The medical scheme took off on a false start with many patients in private and public hospitals complaining of being denied services. SHA is still trying to find firm footing after it replaced the National Health Insurance Fund (NHIF) in October, 2024. 

Registration for SHA has been slower than expected due to lack of public awareness on how the medical scheme works, and misinformation. “Our major obstacle is a knowledge gap,” SHA Chief Executive Officer Robert Ingasira said recently. 

A follow up of Mukoya’s case with the SHA revealed some technicalities that result in SHA being blamed for dragging its feet. 

“In an emergency, hospitals have an obligation to attend to the patient first to save a life, then ask for money afterwards” Job Mokaya, SHA Kakamega Branch Manager said.

While Mukoya was admitted on December 23, it was not until December 26, 2024 that the Mukumu hospital sent a request for pre-authorisation for the surgery to SHA. 

According to records at the hospital, the patient was attended to by a medical officer and a physiotherapist who recommended a CT scan, which was done and it established that he needed surgery. The case was not listed as an emergency. 

The hospital says the delay in seeking pre-authorisation from SHA was caused by the fact that St Elizabeth Hospital Mukumu does not have a resident specialist to read the scan report. It was sent to a sonar imaging center in Kakamega for interpretation and a comprehensive specialist report showing the extent of the injury and to justify the amount of money requested before SHA could act. 

Mukoya got the medical attention and surgical procedure he needed at a cost he could not readily foot from his own pocket at such short notice when SHA took up the matter. 

“There might have been some delay due to the red tape involved, but I am glad that SHA came through for me by authorising such a huge bill. More people should register to reap the benefits” Mukoya said. 

By Christmas, SHA had registered 17 million people and  Ingasira was upbeat that by the end of the year, at least 20 million people will have registered with SHA.