Survey Uncovers Barriers to Patient Access in Kenya’s Social Health Authority Rollout
In picture, The Caucus of Patient-Led Organizations of Non-Communicable Diseases (NCDs) members highlighting significant challenges in the implementation of Kenya’s Social Health Authority (SHA) and Social Health Insurance Fund (SHIF), in Nairobi.
By Aoma Keziah,
A recent survey by the Caucus of Patient-Led Organizations of Non-Communicable Diseases (NCDs) highlights significant challenges in the implementation of Kenya’s Social Health Authority (SHA) and Social Health Insurance Fund (SHIF), which are intended to improve access to essential health services. Conducted across Nairobi, Kiambu, Meru, and Bomet counties, the survey captured insights from public, private, and mission hospitals, uncovering systemic barriers that are limiting patients’ access to timely and affordable healthcare.
Evans Majau, Chair of the Caucus of Patient-Led Organizations of NCDs, noted that the survey findings reveal critical gaps in SHA’s ability to effectively serve Kenyan patients, particularly those with chronic and complex conditions such as cancer, diabetes and cardiovascular diseases
“For SHA to fulfill its promise of universal health coverage, it must prioritize transparency, access to specialized care, and active patient engagement. We call on the Ministry of Health and SHA leaders to urgently engage with patient voices and take corrective action.” He asserted.
Key Findings of the Survey indicates Delays and Inefficiencies in Public Facilities such as Kenyatta National Hospital and Kenyatta University Referral Hospital reported frequent delays, leaving patients waiting hours for services like diagnostic imaging and specialized procedures. Technical glitches and recurring “system hangs” have exacerbated the situation, significantly impacting patients in urgent need of care.
Private hospitals, including Nairobi Hospital and Rurai Family Hospital – Specialty Hospital, have restricted SHIF coverage primarily to civil servants in certain job groups, excluding many NCD patients. High-risk groups, including cancer and transplant patients, now face increased out-of-pocket costs, with services that were once covered under NHIF no longer eligible under SHIF.
Mission hospitals like Tenwek Hospital report no SHIF coverage, limiting rural patients’ access to specialized treatments. Additionally, public hospitals such as Mama Lucy Kibaki and Mbagathi face limitations in performing advanced procedures, such as cardiac surgeries, further constraining care for NCD patients.
Common Challenges Identified Across Facilities, Patients are now incurring out-of-pocket expenses for primary care services previously covered under NHIF, adding financial strain for NCD patients needing regular care, healthcare providers have raised concerns over outstanding NHIF bills and unclear SHA benefit structures, which discourage facilities from accepting SHA patients due to fears of delayed or denied reimbursements.
The SHA has suspended coverage for overseas treatments, leaving patients needing specialized care with limited options if those services are not available locally and lack of information about SHA benefits, premium structures, and eligibility criteria has left many patients unprepared for SHA’s changes, further complicating access to care.
Recommendations from the Caucus of Patient-Led Organizations of NCDs, in response to the survey’s findings, the Caucus urges the Ministry of Health and SHA Management to address these critical issues through the following actions: Resume Overseas Treatment Coverage for patients needing specialized care unavailable in Kenya, increase transparency and rebuild patient trust, improve patient experience and reduce waiting times, reassure providers and lessen the financial burden on patients, educate citizens on SHA benefits, eligibility, and financing options and ensure patient-focused solutions in SHA’s implementation.
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The Mt Kenya Times 