Patients' pain and confusion mark transition to new health care scheme

Health CS Deborah Barasa (center), PS Medical Services Harry Kimtai (left) and SHA Chairperson Dr Abdi Mohamed before National Assembly's Health Committee to discuss the rollout of the  Social Health Insurance Fund (SHIF) in preparation for the Universal Health Coverage launch on 1st October 2024 [Elvis Ogina, Standard]

The transition from the National Health Insurance Fund (NHIF) to the Social Health Authority (SHA) began yesterday amid widespread frustration and confusion.

Uncertainty was palpable in hospitals nationwide, where some patients had to wait for their details to be approved while others were turned away.

Many patients reported being forced to pay for essential services, such as dialysis, out of pocket.

“I used to work as a nurse at Mbagathi Hospital and would visit the clinic whenever I was sick. Today, I encountered people registering for a new system I wasn’t aware of. I tried to register, but was told I couldn’t access the system immediately. As someone who needs daily medication, this worries me greatly. When will my new card be ready for me to access my drugs? No one has provided a clear answer,” said Rose Adero-Opiyo, a heart patient.

Adero-Opiyo’s experience highlights the lack of communication regarding the transition process, reflecting the impact on patients with chronic conditions.

In Makueni County, the new health insurance fund has already caused distress for patients.

Peter Wambua, a cancer patient, had to return home without treatment after being unable to pay for blood tests and medication out of pocket. Under the NHIF system, cancer treatment was covered, but the new SHA appears to have different provisions.

“We have kicked off. The NHIF era ended yesterday, and now we are in the new era of the Social Health Authority,” said Dr. Alex Irungu, CEO of Mbagathi County Referral Hospital.

Dr. Irungu acknowledged that challenges are common with any new initiative. “Challenges are expected with any new project. We are working closely with the Social Health Authority to address these issues,” he added.

One key challenge is the public’s misunderstanding of the transition process. Many assumed the shift from NHIF to SHA would be automatic, which it is not.

Another issue is the registration process for self-employed individuals, who must pay to register—a hurdle for many.

“It has not been easy for us or the patients we’ve met here, as the registration is not going through. We have tried multiple times but have not succeeded,” said Perry Karanja, a community health promoter at Mbagathi Hospital.

Despite these hurdles, Dr. Irungu remains optimistic. “The principle behind this social health insurance is a brilliant idea. We may face initial challenges due to resource scarcity and competing social needs, but in the long run, I believe this is the best path forward,” he said. The Ministry of Health insists that the transition will benefit low-income earners, projecting that SHA will generate Sh148 billion to improve the country’s quest for Universal Health Coverage (UHC).

Yesterday, SHA acting CEO Elijah Wachira reported that at least 600,000 people had registered in the SHA system.

Wachira attributed some of the issues to certain hospitals failing to register as service providers.

While the government promotes the new system, Kenyans have taken to social media to express their frustrations.

In Nyanza, patients seeking services at various health facilities reported being subjected to mandatory transfer to the new system.

In Migori County, patients with NHIF cards had to register in the new system before receiving treatment.

Raphael Ochom, whose patient was in the maternity ward, found himself stranded after being told the Linda Mama programme was no longer available. “I hadn’t registered for SHA and didn’t know how to do so, but I was directed where to go,” Ochom said.

Many patients who visited hospitals in the morning were told to wait to register.

“We were told to wait and register first,” said Mary Adhiambo, a patient.

Those who could not wait opted to pay out of pocket for treatment. “Seeing the long queue, I decided to pay cash to get treatment,” said Jared Omondi, who brought a patient to the facility.

In Kisumu, patients complained of long wait times and a sluggish system that kept crashing.

“I hoped to get services and return home quickly, but I was forced to register for the new system,” said Maurice Okello at Jaramogi Oginga Odinga Teaching and Referral Hospital.

In Homa Bay, some residents opposed the transition, claiming the country was unprepared for the new system. Jack Nyambega, Chairman of the Homa Bay Giant Traders Association, expressed concern about the lack of clarity on how NHIF contributors would be served under SHA.

“We don’t know how we will be treated in health facilities under SHA because the government has not provided clear directions,” Nyambega said.

In Uasin Gishu, residents worried that the new health insurance cover would not resolve challenges experienced under NHIF. At Uasin Gishu Sub-county Hospital, patients were encouraged to register for SHA, though the cover would not serve them immediately.

“Expectant mothers going into labor will have to pay cash because Linda Mama will no longer be available,” said an employee at the facility.

Health Cabinet Secretary Deborah Barasa observed the rollout in Uasin Gishu, one of 15 counties where SHA and the Social Health Insurance Fund (SHIF) were piloted.

In Nakuru, residents expressed uncertainty about what would happen to their NHIF contributions as the transition to SHA proceeded smoothly. Many reported having to register despite lacking information about the programme.

“I’ve been trying to understand this SHA programme but I’m not getting it. With NHIF gone, we have no choice but to register,” said Kevin Wekesa.

George Waiyaki was surprised to learn he could not use his NHIF card following the rollout of SHA.

“I thought I could still use my NHIF while transitioning to SHA, but I found out today at Langa Langa Hospital that it’s no longer working. I plan to register, but I don’t understand the details of the SHA programme,” he added.

Mary Wambugu, an expectant mother, was concerned about her NHIF payments. “I paid for NHIF for the whole year, and since it’s not working, I don’t know if the money will be transferred to my SHA account for my medical services,” Wambugu said.

In Nyahururu, where the new SHA offices are based to serve Laikipia and Nyandarua counties, residents expressed dissatisfaction with the new system. They voiced concerns over whether it would cover chronic diseases like cancer and diabetes.

“We were advised to wait until the new system is operational, which is why we’ve been forced to seek treatment at private hospitals,” said Jane Muthoni, a patient.

Report by Maryanne Muganda, Anne Atieno, James Omoro, James Munyeki, Lynn Kolongei and Hilda Otieno