Patient Service Access Survey Reveals Major Challenges in Social Health Authority Rollout in Selected Kenyan Counties

 

By Bruno Aero

The Caucus of Patient-Led Organizations of Non-Communicable Diseases (NCDs) has released the findings of a survey conducted between October 24 and 25, 2024,) uncovering significant hurdles in the initial implementation of Kenya’s Social Health Authority (SHA) and Social Health Insurance Fund (SHIF). The survey exposes widespread obstacles that hinder access to essential, affordable care for patients with chronic conditions, while also placing undue strain on healthcare facilities across Nairobi, Kiambu, Meru, and Bomet Counties.

The survey gathered input from public, private, and mission hospitals, revealing critical system inefficiencies, gaps in SHA coverage, and limited public understanding of SHA benefits.

Key Findings:

1. Access Delays and System Inefficiencies:
   Patients experience hours-long waits for diagnostics and specialized services at public hospitals, such as Kenyatta National Hospital and Kenyatta University Referral Hospital. Dr. John Gikonyo, Vice Chairman of the NCD Alliance and President of the Renal Patients Society of Kenya, highlighted frequent system “hangs” that intensify patient distress.

2. Limited SHA Coverage in Private Facilities:
   Several private hospitals, including Nairobi Hospital and Ruaraka Uhai Neema Hospital, restrict SHIF coverage to certain civil servant job groups. As a result, most NCD patients must make out-of-pocket payments, with cancer and transplant patients among the hardest hit.

3. Inconsistent Access to Specialized Care:
   Mission hospitals like Tenwek Hospital do not offer SHIF coverage, leaving rural patients without necessary specialized treatment. Additionally, public hospitals like Mama Lucy Kibaki and Mbagathi hospitals lack advanced procedure options for SHA patients, such as cardiac surgeries, limiting life-saving care.

4. Additional Challenges Across Facilities:

   • Outpatient and Drug Refill Services: Previously covered primary healthcare services now require out-of-pocket payments.
   • Unresolved NHIF Debts and Lack of SHA Clarity: Providers remain hesitant to accept SHA patients due to unpaid NHIF bills and unclear benefit structures.
   • Suspension of Overseas Treatment Coverage: SHA’s suspension of overseas treatment coverage restricts access to specialized medical care.
   • Limited Public Awareness: Many patients are uninformed about SHA benefits, premiums, and eligibility.

Recommendations:

The Caucus of Patient-Led Organizations of NCDs urges the Ministry of Health and SHA management to act on these key recommendations:

• Resume SHIF Coverage for Overseas Treatment to provide necessary specialized care unavailable in Kenya.
• Clarify SHA Benefit Structures to increase transparency and patient trust.
• Address System Failures Promptly to reduce waiting times and improve registration, preauthorization, and payment processes.
• Settle Outstanding NHIF Debts to enable providers to accept SHA patients confidently.
• Launch Public Awareness Campaigns to educate Kenyans about SHA benefits and registration requirements.
• Engage Patient Organizations and Civil Society to ensure solutions are patient-centered.

Dr. Gikonyo emphasized, “The survey findings reveal critical gaps in SHA’s ability to serve Kenyan patients effectively, especially those facing chronic and complex conditions like cancer, diabetes, and cardiovascular diseases. The SHA rollout must prioritize transparency, access to specialized care, and patient inclusion to fulfill the promise of universal health coverage in Kenya. We urge the Ministry of Health and SHA leaders to engage with patient voices and take swift, corrective action to address these issues.”

The Caucus of Patient-Led Organizations of NCDs remains committed to advocating for equitable healthcare for all Kenyans and will continue efforts to achieve accessible and affordable healthcare for those in need.