The system delays, technical hitches and missing benefits greatly affect Kenyans with cancer, diabetes and heart conditions- Survey
The rollout of the Social Health Authority (SHA) continues to face myriad challenges including system delays, technical failures and missing medical services, according to a recent survey.
The survey by the Caucus of Patient-led Organizations of Non-Communicable Disease (NCDs) in Kenya also revealed significant systemic challenges in implementing SHA and Social Health Insurance Fund (SHIF) including limited coverage of SHA in private hospitals, which leaves most people with NCDs ineligible.
The survey conducted between 24th and 25th October 2024 in public, private and mission hospitals in Bomet, Nairobi, Kiambu, and Meru also exposed serious gaps that hinder patients with NCDs from accessing basic and specialized treatments.
Evans Majau, the chairperson of the Caucus of Patient-led Organization of NCDs, notes that public hospitals like Kenyatta National Hospital and Kenyatta University Referral Hospital reported frequent system delays that left patients waiting for hours to access critical services, including diagnostic imaging and diagnostic procedures.
“Patients have experienced systemic issues in many facilities where technical failures and system hangs were common, exacerbating patients’ distress,” says Majau adding that elaborate packages for people with NCDs namely renal, cancer, diabetes and mental health were not available under SHA, forcing patients to pay out of pocket, yet they were receiving the services under the now defunct, NHIF.
“There is a need for the Ministry of Health to tell people what is available or not, what is possible or not possible so that they know what to expect,” he said, noting that SHA coverage in some private facilities is restricted to civil servants in specific job groups.
“NCDs are life-long conditions that affect the biological system of a person and any interruptions in treatment and care, as has been witnessed since the launch of SHA are going to affect the patients with NCDs,” says Catherine Karekezi, the Executive Director of NCD Alliance Kenya. “Cancer is not waiting for the patients to sort out SHIF issues, it is progressing, and if they are not going to access treatment and care, it is going to have a severe impact on the quality of life and possibly lead to premature death.”
The survey also showed that some hospitals were unable to perform advanced procedures like cardiac surgeries for SHA patients, severely limiting life-saving interventions for NCD patients.
Besides unresolved NHIF debts and lack of clarity on SHA benefits, Majau says some health providers were reluctant to offer services fearing reimbursement delays or exclusions, severely affecting patients with chronic and complex conditions like cancer, diabetes and cardiovascular diseases,” says Majau.
The survey also revealed that SHA had suspended coverage for overseas treatment leaving many patients without options for specialized care not available in Kenya.
According to the Vice Chairperson of the NCD Alliance Kenya, Dr John Gikonyo, no patients were being funded by SHIF to go for treatment abroad and those already getting the treatment overseas were unable to continue after the transition.
“The hospitals that have been handling patients overseas are not paid by NHIF for the last two years and under SHA, the authority has not yet contracted overseas service providers which is an ongoing process that needs to be expedited,” said Majau
However, the Cabinet Secretary for Health, Dr Deborah Barasa, clarified that the stranded will be addressed on a case-by-case basis and plans were in place to help clear medical bills for Kenyans stuck in hospitals overseas and “they reach out through the call centre at the Social Health Authority and each case will be addressed accordingly,” said Dr Barasa.
Since SHA was rolled out, some patients have been stuck in hospitals overseas over delayed disbursement of funds by the Kenyan government.
Majau cited the cases of an 11-year-old detained in hospital over pending bills, a 14-year-old whose bills were still accumulating, two renal, one heart, and one pediatric patient whose bills are pending, including one pediatric case detained in Fortress Memorial Hospital in India.
“The Ksh500,000 the government had issued as a Guarantee of Payment must be honoured before they release the baby to go home,” explained Majau who lamented about the baby scheduled for an open-heart surgery last week but died waiting for documents to be released from NHIF buildings.”
Majau noted that renal patients were getting dialysis treatments, despite initial challenges in the first weeks, but since then, they have been getting services including kidney transplants at Kenyatta National Hospital and Moi Teaching and Referral Hospital.
Dr Gikonyo also explained that NCD patients had to go to level 2 and 3 facilities for referrals resulting in mental torture leading to a deterioration of their health.
