Patients are grappling with a compounded healthcare crisis as the rollout of the new Social Health Insurance Fund (SHIF) continues to face major hurdles countrywide.
Health Cabinet Secretary Deborah Barasa came face to face with the challenges encountered in the rollout of Social Health Authority (SHA) system as a renal patient in Nakuru who had missed two dialysis sessions tried to reach out to her.
Baraza who was in Nakuru to evaluate the rollout of the healthcare financial services system could not help George Mwangi who had been turned away from various facilities due to lack of money.
Mwangi said since the rollout of SHA he has gone through difficult times in order to access treatment.
"I have only managed to pay for one session which was done last week. I have missed 2 sessions already, I have been moving from one facility to the other which am required to pay sh 20,000 which I can't afford, “posed Mwangi.
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Mwangi said he was required to pay at least Sh9,500 per session; he had been going for 2 sessions every week which was being Paid by NHIF.
He added that he had already paid for his annual NHIF payments which has not yet been reimbursed.
"I had already paid my NHIF, it was up to date. I thought the rollout would be seamless. I had to walk from home to come to look for a dialysis facility that can assist me, even after reaching out to Cabinet Secretary for Health who has no assisted. I will have to walk back home without treatment, “he said
Barasa said most renal patients had registered under SHA and were receiving treatment in both public and private hospitals across the country.
She said the patients have benefitted from the new scheme adding that they have increased the dialysis session from 2 to 3 sessions.
She, however, admitted that since the system was down, many patients were forced to pay from their pockets.
She explained that the reimbursement would be done through formal claims that have been done manually or digitally through the various facilities that have offered services.
She also urged hospitals and facilities to take care of patients, even those who cannot afford and make claims through the ministry for payments.
"I am asking hospitals and facilities that are attending to patients especially those with terminal illnesses like cancer and those who require treatment not to turn away the patients," she said.
A growing number of service providers, including dialysis centers, and private hospitals threatened not to on-board the new system, citing unpaid debts and unresolved issues from the defunct NHIF.
The transition to SHA was intended to streamline healthcare services, but the reality on the ground tells a different story.
With NHIF owing dialysis service owe providers more than Sh10 billion, many hospitals are refusing to join SHA until their outstanding payments were settled.
This delay is already affecting the availability of essential services, leaving patients stranded and unable to access critical treatments, with kidney and cancer patients being the recent most affected group.
Frustrated by NHIF’s inability to fully remit claims, dialysis providers are now refusing to transition to the new system.
“We have worked closely with NHIF for over two decades to provide quality health care for patients with kidney disease, however, we are deeply concerned by the NHIF’s failure to readjust the reimbursement rate to match the market condition and to fully remit claims,” says Dr Jonathan Wala, chairman, Kenya Renal Association.
He added: “This financial shortfall has forced several dialysis units to shut down, undoing much of the progress made. The now-defunct NHIF owes dialysis providers more than Sh10 billion with no formal mechanism in place to address the crippling debt.”
With the rollout of SHIF, the association indicated that they had hoped for improvement in service delivery and the establishment of a clear and transparent framework for reimbursement but this is not forthcoming.
“We have submitted several recommendations to SHA to address critical gaps in kidney health services but nothing is forthcoming, instead we have since witnessed a chaotic roll with patients being turned away from hospitals,” Wala said.
He added “Our patients are currently facing life-threatening uncertainty due to the disorganised SHA rollout, many making out-of-pocket payments, missing sessions, non-citizens not allowed to register with new patients unable to access treatment.”
Wala said providers have not signed a formal contract with SHA as dictated by the regulations: “The promised digital contract system is yet to be implemented, leaving providers uncertain about their legal standing.”
The association has, therefore, called upon the government to come up with a formal contract with the service providers without delay. Also, the provision of clear and consistent guidelines for patients and providers to ensure uninterrupted service delivery.
“SHA must implement our previous recommendation to improve kidney health coverage in the country including extending dialysis cover to three sessions and expanding transplant services,” says the statement.
The problem with dialysis is not just the interruption of services but even if the services were in place, the sessions have been reduced and the allocation reduced from Sh9,500 to Sh2,375, according to the new proposal benefits.
Hospitals are now sending messages to patients on clinic days to come up with an additional sum of Sh7,000 in cash to top up for their dialysis sessions.
Dialysis is a life-saving procedure, and without timely treatment, many patients could suffer serious health complications or even death.