A few weeks ago, Raphael Ochieng witnessed firsthand the devastating impact of the Social Health Insurance (SHA) system’s failures. His colleague, desperate for help, called him in a panic his wife was in labor and needed urgent medical attention. Confident that she was covered under SHA, they rushed to a Nairobi hospital, only to be met with a crushing reality: she was not registered in the system.
Unaware that SHA classifies individuals aged 25 and above as a separate household, Ochieng’s colleague had assumed his wife remained his dependent, just as she had been under the now-defunct National Health Insurance Fund (NHIF). Even after proving that he had made all required payments, hospital officials insisted she was not covered.
Desperate, they attempted to resolve the issue by visiting multiple offices and cyber cafés to register her afresh. But the SHA system was down, leaving them in limbo. As the delay continued, her condition worsened.
After being referred to Kenyatta National Hospital for specialized care, tragedy struck—she passed away just minutes after arrival.
Ochieng is still haunted by the ordeal. “We even paid out of pocket, but it still wasn’t enough to save her. Now, we are struggling to raise funds for her funeral, all because of a broken system,” he lamented.
Ochieng’s story is just one of many. Across Kenya, SHA’s operational failures are leaving patients stranded and families in financial distress. The inability to access timely care has led many to question the system’s reliability.
Joseph Waicungo, a manual laborer, echoes similar concerns. Despite being enrolled in SHA, he still had to pay KSh 1,500 out of pocket for treatment. “I didn’t even have that money at the time,” he recalled. “I had to choose between seeking treatment or buying food for my pregnant wife.”
Waicungo’s case highlights a grim reality for millions of Kenyans. With the rising cost of living, many are forced to prioritize basic needs over healthcare. “When I get sick, I just wait. If I can endure the pain, I will,” he admitted.
Since SHA replaced NHIF, over 4.3 million Kenyans who were automatically transitioned have yet to update their profiles. While the Ministry of Health reports that 18.8 million individuals have registered, only 3.3 million have completed the required scientific means testing to determine their eligibility.
Compounding the issue is the government’s plan to use data from agencies like the Kenya Revenue Authority (KRA) and Hustler Fund to determine contributions. While this is meant to curb fraudulent claims, many fear it will result in unaffordable premiums, particularly for informal sector workers.
The crisis escalated when the Rural & Urban Private Hospitals Association of Kenya (RUPHA) announced that its member hospitals would cease treating teachers, police officers, and SHA patients due to unpaid government bills and persistent system failures.
Dr. Brian Lishenga, RUPHA’s chairperson, expressed frustration over the situation. “Hospitals are defaulting on loans, medical supplies are running out, and consultants haven’t been paid for years,” he stated.
According to RUPHA, 89% of hospitals have experienced SHA portal failures, making it impossible to verify patient eligibility. Furthermore, only 54% of hospitals have received payments, placing immense financial strain on healthcare providers.
As millions of Kenyans struggle to access medical care, the government faces mounting pressure to fix SHA’s systemic issues. The World Health Organization (WHO) has warned that excessive out-of-pocket payments are pushing many Africans into poverty, making universal healthcare an increasingly distant dream.
For now, many Kenyans are left with an impossible choice gambling with their health or falling deeper into financial ruin. The question remains: how many more lives must be lost before real change is made?
