Many Kenyans continue to struggle with medical bills despite being registered and paying monthly contributions to the Social Health Authority (SHA). Recent rule changes have left patients stranded in hospitals, unable to access the care they were promised.
One such case is that of Moses Ndolo, a security guard whose wife was admitted to Coast General Teaching and Referral Hospital (CGTRH) in critical condition. Ndolo, unaware of the new requirement to notify SHA within 24 hours of admission, later discovered that his medical coverage would not be honored due to this oversight. He had been consistently paying his SHA contributions, yet he was told he must find his own way to cover the growing hospital bill, which had reached Sh138,720. Additionally, his wife required an X-ray at another facility, costing Sh25,000, an amount he could not afford.
This lack of communication regarding policy changes has left many patients in dire situations. There has been little to no sensitization on the new rules, and hospitals are not informing patients about the requirement to notify SHA within 24 hours. Many who have faithfully contributed to the program find themselves stranded with overwhelming bills.
Another affected individual is Khamis Thoya, a boda boda rider who took his elder brother, Richard, to CGTRH on February 17. Due to an incomplete SHA registration, Richard’s medical bills were not covered. After a month of treatment, he passed away on March 17, leaving behind a bill of Sh522,000. Thoya, already struggling to make ends meet, was devastated. With another brother now paralyzed and unable to work, he found himself in an impossible situation. The hospital refused to release the body until the bill was paid in full, adding a separate mortuary fee to the already insurmountable costs.
For many like Thoya, raising such amounts is unthinkable. Earning around Sh800 on a good day, he has little hope of clearing the debt. Frustrated and defeated, he suggested that the hospital could simply keep the body if they wished, as he saw no way to resolve the situation.
The crisis has drawn attention from leaders, who have witnessed firsthand the struggles Kenyans face in accessing healthcare. One senator, after visiting CGTRH and speaking to patients, acknowledged the deep flaws in the system. Despite efforts to encourage Kenyans to register with SHA, the reality on the ground paints a different picture. Those who are registered and paying still find themselves unable to access services, while those unregistered are left without options.
A key issue raised is the failure of SHA to properly communicate changes in policy. Patients like Ndolo, who diligently paid their contributions, should not be penalized for lacking awareness of rule changes that were never effectively disseminated. The requirement to notify SHA within 24 hours of admission was introduced without adequate public education, leaving many in distress.
Hospitals also bear responsibility. Medical professionals, aware of the necessary procedures, could have guided patients to ensure compliance. Instead, many patients are being asked to pay out of pocket, raising concerns about whether hospitals prefer direct payments to avoid delays in reimbursements from SHA.
Despite these challenges, the government maintains that SHA is fully operational and continues to serve many Kenyans. Leadership has reaffirmed its commitment to improving universal healthcare and addressing the issues that have emerged. However, for those currently stranded in hospitals, facing insurmountable bills and uncertainty, the reality remains grim.
The situation underscores the urgent need for better communication, transparency, and accountability in the implementation of SHA policies to prevent further suffering among Kenyans who rely on the program for essential healthcare.
