By Cynthia Masibo
A new survey by the Caucus of Patient-Led Organizations of Non-Communicable Diseases (NCDs) has unveiled significant challenges in Kenya’s Social Health Authority (SHA) rollout, affecting patient access to essential health services.
The survey, conducted from October 24 and 25, involved public, private, and mission hospitals across Nairobi, Kiambu, Meru, and Bomet Counties.
Findings indicate that patients with chronic conditions like cancer, diabetes, and cardiovascular diseases are particularly affected by systemic issues that hinder timely and affordable healthcare access.
The survey highlights serious obstacles across different types of healthcare facilities. Public hospitals such as Kenyatta National Hospital and Kenyatta University Referral Hospital reported persistent delays in accessing critical services, including diagnostic imaging and specialized procedures.
Frequent “system hangs” and technical failures in these hospitals added to patient distress, with many waiting hours for essential care.
Private facilities like Nairobi Hospital and Ruaraka Family Hospital – Specialty Hospital restricted Social Health Insurance Fund (SHIF) coverage mainly to civil servants, limiting access for the majority of NCD patients.
This gap has left high-risk groups, such as cancer and transplant patients, increasingly reliant on out-of-pocket expenses for treatments that were once covered under the National Hospital Insurance Fund (NHIF).
In mission hospitals, such as Tenwek Hospital, the lack of SHIF coverage has created major barriers to specialized care for rural patients. Public facilities like Mama Lucy Kibaki Hospital and Mbagathi Hospital reported an inability to perform advanced procedures, such as cardiac surgeries, for SHA patients, leading to a gap in life-saving interventions.
Across public, private, and mission facilities, patients face rising out-of-pocket expenses for primary care services and drug refills previously covered under NHIF. This financial strain has severely impacted access to basic healthcare for NCD patients. Additionally, many healthcare providers expressed concern over unpaid NHIF bills and unclear SHA benefit structures, making them hesitant to offer services due to fears of reimbursement delays.
The SHA has also suspended coverage for overseas treatments, which has left some patients without options for specialized care not available in Kenya. Furthermore, limited public awareness about SHA benefits and eligibility requirements has left many patients unprepared for the new system.
Based on the survey results, the Caucus of Patient-Led Organizations of NCDs is calling for immediate improvements in SHA’s implementation to better serve Kenya’s NCD patients. Recommendations include resuming SHIF coverage for overseas treatment, clarifying SHA benefits to restore patient trust, and resolving technical issues to reduce patient wait times. The organization also urges the Ministry of Health and SHA management to address outstanding NHIF debts to enable providers to confidently accept SHA patients without financial concerns.
Additional suggestions include launching public awareness campaigns to educate Kenyans on SHA benefits and eligibility, and engaging patient organizations and civil society to ensure patient-centered solutions.
Evans M. Majau, Chair of the Caucus of Patient-Led Organizations of NCDs, emphasized the importance of these changes.
“The survey findings reveal critical gaps in SHA’s ability to serve Kenyan patients effectively, especially those facing chronic and complex conditions. 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 the health needs of all Kenyans, hoping that collaboration and decisive action will lead to a healthcare system that guarantees timely, quality care for every patient.
