The Mt Kenya Times 
By Mr. Fredrick Kipchumba Chelimo – PWD
Email; fkipchelimo@yahoo.com
“The true test of a healthcare system is not what it promises in an office, but what happens to a patient at the moment of greatest vulnerability.”
When someone prepares food for you and brings the dishes praising as the best meal ever without eating the same food, you need to get more worried. Kenya’s top political and executives designed, developed and implemented a healthcare system and informed the citizens it was one of the best ever. They even committed our money to a purported best digital platform in the world. They even contributed generously into the much-hyped SHA universal health care system. To our amazement, we had to pay another exclusive health care insurance for them. The did not trust what they invented. This scenario is mind boggling. It creates more than suspicion, distrust and skepticism in our medical care.
There are moments when a nation must pause and ask whether a reform designed to solve an old problem is quietly creating a new one. Kenya’s Social Health Authority, SHA, has reached such a moment. It was conceived as a major step towards universal health coverage, replacing the National Hospital Insurance Fund with a system intended to pool resources more equitably, digitise healthcare financing and reduce the financial burden of illness. The ambition is legitimate. The question is whether the experience of the Kenyan patient is yet matching the ambition.
I write about this not as a health-sector official, political spokesman or consultant defending an institutional position, but as a patient who has personally experienced the vulnerability that comes with needing medical care, and as someone whose lived experience has brought me into close contact with the barriers confronting persons with disabilities. Illness has a way of stripping away the abstractions of policy. At a hospital counter, one does not experience “universal healthcare coverage” as a statistic. One experiences a queue, a registration process, an authorisation, a diagnosis, a prescription, a bill and, sometimes, the anxious question of whether treatment will actually be accessible.
That personal experience has made me less interested in political declarations and more interested in what happens between the patient and the healthcare provider. To be fair, SHA has not been without measurable progress. The Ministry of Health reported in June 2026 that more than 31.39 million Kenyans had registered, 11,034 facilities had been contracted and KSh147.37 billion had been paid in claims since October 2024. It also reported that more than 1.16 million safe deliveries had been financed through the scheme. Those are substantial numbers and should not be dismissed simply because citizens have legitimate complaints.
But numbers of registration and money disbursed cannot, by themselves, prove that a health system is working for the patient.
The Government has itself acknowledged some of the operational difficulties. In April, the Ministry reported a 74 per cent claims settlement rate and a 90-day payment timeline. More recently, the Ministry and Council of Governors agreed that clean claims should be paid within 90 days, while unpaid verified claims caused by insufficient funds would be recognised as certified liabilities and carried forward for settlement within the financial year, subject to appropriations. The fact that such measures are necessary is important. It tells us that the central challenge is not simply whether SHA exists, but whether the financing chain from contribution to provider payment to patient service is reliable.
The current transition to the SHA Health Management Information System also deserves scrutiny. The Ministry says the new architecture will enable real-time patient verification, electronic claims management and secure information exchange. By June, 5,078 facilities were reportedly operating on SHA-HMIS, with 2,978 actively submitting electronic claims. Digitalisation can indeed reduce fraud and improve accountability. But technology is only as good as the institutions, connectivity, training, data governance and human support behind it. A patient cannot eat a digital dashboard.
This is particularly important for persons with disabilities, older people, rural families and citizens who are not technologically confident. A healthcare system becomes exclusionary when the patient is expected to understand technical processes that even providers sometimes struggle to navigate. Accessibility must therefore mean more than ramps and physical entry. It must include accessible information, respectful communication, predictable authorisation, reasonable accommodation and a human being capable of resolving a problem when the digital system fails.
Kenya also cannot discuss SHA honestly without confronting the financial burden that households continue to carry. World Bank data based on the WHO Global Health Expenditure Database show that out-of-pocket spending accounted for about 24.2 per cent of Kenya’s current health expenditure in 2023. WHO cautions that high out-of-pocket payments are associated with catastrophic and impoverishing health expenditure because households bear the cost directly rather than sharing the risk through pooled financing. This true for ordinary Kenyan and exponentially high for persons with disabilities.
That is the measure that should worry policymakers most. Universal health coverage should mean that illness does not become a pathway into poverty. The reform agenda therefore needs to move beyond defending SHA and become much more practical. First, the Government should publish a simple, continuously updated benefits-and-tariffs dashboard showing what is covered, at what level, under what conditions and what a patient should do when a claim or authorisation is rejected. The public should not need a lawyer, accountant or hospital administrator to understand its medical entitlement.
Second, every SHA rejection should carry a clear, patient-understandable reason and an accessible appeal mechanism with defined turnaround times. Third, the 90-day clean-claims commitment should be monitored publicly, facility by facility and month by month. Fourth, SHA should publish meaningful data on rejected claims, pending claims, certified liabilities, provider payments and patient complaints—not merely aggregate registration figures.
Fifth, the Government should establish independent patient-support and escalation desks at major public hospitals, with particular attention to persons with disabilities, elderly patients and other vulnerable groups. Sixth, the transition to new digital systems should never result in denial of urgent care because a platform is unavailable. There must always be a functional human fallback.
Seventh, procurement, tariffs, contracting and system-development costs should be subject to rigorous public accountability. A healthcare system built on compulsory contributions owes contributors more than assurances; it owes them evidence.
There is also a broader lesson. The recent HAKIKA contracting framework recognises concerns around tariffs, claims processing, payment delays, pre-authorisation and system reliability and seeks clearer contractual obligations and dispute-resolution mechanisms. This is a welcome acknowledgement that reform is still a work in progress. Kenya should therefore resist the temptation to declare victory before the patient feels the difference.
SHA does not need propaganda. It needs credibility. The citizen does not ask whether the system has impressive software. The citizen asks whether treatment is available when needed, whether the hospital can verify coverage without confusion, whether the claim is honoured, whether medicines are available, whether the bill is predictable and whether someone will listen when things go wrong.
My own medical experience has taught me something that policy documents sometimes forget: when a person is unwell, dignity becomes part of treatment. A patient should not have to fight the system while simultaneously fighting illness. Kenya therefore does not need another political hymn about how transformative SHA is. It needs a health system whose performance can withstand independent scrutiny and whose failures are corrected without defensiveness.
“A healthcare reform becomes a success not when government says it works, but when the patient no longer fears what will happen when illness arrives.”
That is the standard Kenya should demand of SHA. Not perfection. Not political applause. But reliability, dignity, transparency and measurable protection from the financial shock of illness.
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