Health & Science

By Standard Team | Nov. 02, 2024

A month after the government rolled out the Social Health Authority (SHA), several patients across the country claim that accessing healthcare has become a nightmare. Many have claimed they were forced to pay out of pocket for services that were previously covered by the defunct National Health Insurance Fund (NHIF).

Their concerns come as several health facilities express uncertainty about whether the government will reimburse them for services provided to patients.

In Migori County, Fredrick Akoko, who took his mother to a hospital in Ranen, Awendo sub-county last week, said he was compelled to pay for treatment in cash. “I had to pay cash because the hospital does not accept SHA,” Akoko said.

Martin Bhoke, a patient admitted to Migori County Referral Hospital, also reported paying cash for services. A spot check at the hospital’s outpatient section revealed that patients were required to pay cash as well.

However, Migori County Health CEC Caleb Opondi claimed that SHA was functioning at the referral hospital and sub-county hospitals.

Similarly, in the western region, several patients stated they were paying out of pocket for services despite having registered for the new healthcare insurance. The most affected groups include expectant mothers under the Linda Mama scheme, cancer patients, and those requiring dialysis.

Some patients mentioned they had not signed up for the new health plan due to system hitches.

In the Rift Valley, patients reported struggling to access the SHA system, despite the government’s promise to make Universal Health Coverage a reality.

Patient data

The Saturday Standard has established that while system challenges affecting patients have largely been resolved, the situation is different for some medical facilities, some of whom have resorted to manually recording patient data and filing claims later. “

“The system is experiencing some downtime, but patients have to be served. The records are kept manually with the hope that once the system is restored, the data can be entered,” said a medical worker who wished to remain anonymous.

Kelvin Etyang, a dialysis patient at Nakuru Level Five Hospital, praised the new SHA but acknowledged facing numerous challenges at the beginning.

“I started dialysis sessions in March this year under NHIF. At the onset of SHA, we struggled to log into the system; without access, we couldn’t be served,” Etyang said.

The 24-year-old added that he could not afford to pay for dialysis out of pocket, and the delays caused him suffering. “Today, I have gained confidence in the system. I no longer pay for laboratory tests; I only pay for some medications out of pocket,” he noted.

Dialysis session

Cyrus Kariuki, another dialysis patient, reported that the system works well for him, except for certain costs that are not yet covered by SHA. “After a dialysis session, one receives an injection to boost red blood cell production and prevent anemia. SHA isn’t covering that injection right now, and it costs Sh1,600,” Kariuki explained.

At the hospital’s oncology unit, Beatrice Muthoni, who undergoes two blood tests and one chemotherapy session per month, shared her experience transitioning to the new system.

“NHIF required booking a chemotherapy session week in advance. Under SHA, the session can be booked in the morning and approved within two hours, making it more efficient,” Muthoni said.

However, she noted that at the beginning, the SHA system posed risks due to delays.

“I was scheduled for a blood test the same day SHA rolled out. I had to return to the hospital three times before the system worked. Without that test, I couldn’t undergo chemotherapy,” she recalled.

David Mwaura, another cancer patient at the facility, echoed her sentiments. “I struggled to log into the system during the first few days. It was slow but appears to be improving over time. Today, everything went through within 25 minutes, and I was placed under chemotherapy,” he said.

However, he mentioned that while many Kenyans have transitioned to the new system, many details remain unclear to them.

Nakuru Level Five Hospital Deputy Medical Superintendent, Dr Samuel Wanjara, stated that the adoption of SHA at the facility has been seamless, as they guide patients through the transition.

At Kakamega County General Hospital, Kevin Kateri, 31, sat deep in thought in the facility’s maternity wing, wondering how to raise Sh7,000 to settle the bill incurred after his wife gave birth.

Linda Mama

“My wife gave birth two days ago,  but she cannot leave the hospital because I need to pay Sh7,000 for her release. The Linda Mama scheme under NHIF is not working; I’ve been told to register for SHA. I’ve tried registering, but it has been unsuccessful,” Kateri said.

He urged the county government to intervene and allow his wife to leave the facility since she had registered under the Linda Mama scheme.

Kakamega County Executive Committee Member for Health, Dr Benard Wesonga, noted that some patients are still arriving at facilities with defunct NHIF cards, making it difficult to offer them services.

“We have cases of people being forced to pay cash because we cannot treat them for free if they are not registered under SHA,” said Wesonga.

In the Mount Kenya region, some patients reported that the first month of SHA has denied them vital services.

Patrick Munene, who sought medical help at Nyeri County Referral Hospital for chest complications, said he had to borrow money to pay for his treatment in cash.

At Guardian Hospital in Meru’s Igembe region, the facility’s human resources officer Agnes Kendi said there was a problem with registering underage maternity patients as they have no IDs.

The edit icon for phone numbers was is not functional in case one is registered wrongly, she said.

[Report by Kennedy Gachuhi, Anne Atieno, Phares Mutembei, Benard Lusigi and Purity Mwangi]