State to Refund Sh9,500 Nakuru Patient Paid for Dialysis After Social Health Authority Transition

The transition from the National Health Insurance Fund (NHIF) to the Social Health Authority (SHA) in Kenya, while aimed at improving healthcare service delivery, has faced teething problems that have caused distress to many patients. One such individual is James Kanyore, an elderly man from Nakuru, who found himself in a deeply emotional and difficult situation. Denied access to his regular dialysis treatment under the NHIF, he was asked to pay Sh9,500 in cash, an amount he couldn’t afford. His story not only highlights the challenges patients have faced during this transition but also raises questions about the readiness of the healthcare system to handle the migration and ensure no patient is left behind.

The Transition from NHIF to SHA

The Kenyan government, on October 1, 2024, officially launched the Social Health Authority (SHA), replacing the NHIF as the nation’s primary health insurance scheme. This transition was part of broader reforms aimed at improving the accessibility, efficiency, and sustainability of healthcare services across the country. One of the key aspects of this shift was the establishment of the Social Health Insurance Fund (SHIF), which replaced the NHIF’s financial structure.

The NHIF had been Kenya’s flagship health insurance program for decades, providing medical coverage to millions of Kenyans, particularly for those with chronic illnesses like James Kanyore. With the transition to SHA, the government aimed to introduce a more robust and inclusive healthcare framework. Under the new system, contributions would be more structured, and coverage would extend to a broader range of services, addressing issues that had previously hindered NHIF from reaching its full potential.

However, as with any major systemic change, the transition has not been without challenges. Many patients who had been using NHIF for years suddenly found themselves in a state of uncertainty. The migration of their accounts to SHA wasn’t seamless, leading to confusion, delays in accessing services, and in some cases, out-of-pocket expenses they hadn’t anticipated.

Kanyore’s Heartbreaking Experience

James Kanyore’s case came to the public’s attention after a Citizen TV broadcast showed the elderly man breaking down in tears, recounting his struggle to get dialysis treatment. For years, Kanyore had relied on NHIF to cover the costs of his dialysis sessions, a critical and life-sustaining treatment for patients with kidney failure. Dialysis is a process that mimics kidney function by filtering waste products and excess fluid from the blood, and for many patients, it’s a necessity they cannot afford to miss.

With the transition to SHA, Kanyore, like many others, found himself caught in the middle of a bureaucratic shift. When he arrived at the hospital for his dialysis session, he was informed that he had to pay Sh9,500 in cash. The hospital, citing changes in the payment system, was unable to process his NHIF card, which had been his lifeline. This was despite the government’s assurances that no NHIF patient who hadn’t fully migrated to SHA would be denied services or asked to pay from their pocket.

“I have been told to tell my people to pay Sh9,500, but I’m old and I don’t have money. I have nowhere I can borrow,” Kanyore said, tears streaming down his face.

His story struck a chord with many Kenyans, particularly those who have elderly relatives or who have been affected by the complexities of the healthcare system. The sight of a frail, elderly man being forced to navigate these obstacles to access essential treatment highlighted the human cost of the transition.

Government Response

Following the public outcry over Kanyore’s plight, the Social Health Authority’s Director of Corporate Services, Ibrahim Alio, took swift action. Alio confirmed that the SHA had followed up on the case and would ensure that Kanyore’s future dialysis sessions would be covered under the SHA system without any further complications. Moreover, the government pledged to refund the Sh9,500 that Kanyore had been forced to pay out-of-pocket.

“We have seen some patients who have been crying out and suffering, an example was the man who cried on the TV, and we followed up with the patient immediately,” Alio said in a statement. He also reassured the public that Kanyore’s next dialysis session, scheduled for the following Monday, would proceed smoothly.

This case, while resolved for Kanyore, has shed light on the broader challenges faced by patients as the country transitions from NHIF to SHA. Many Kenyans have expressed similar grievances, sharing stories of how they’ve been unable to access medical services due to confusion over the new system. For some, this has meant delays in receiving critical treatments, while others have been forced to pay out-of-pocket expenses they hadn’t anticipated.

A Broader Issue

The case of James Kanyore is just one example of the struggles many Kenyans have faced since the migration from NHIF to SHA. While the government has reassured the public that contributions made to NHIF will remain secure, the transition has not been as smooth as promised. Many Kenyans have experienced difficulties in accessing healthcare services, particularly those in rural areas or those relying on treatments like dialysis that require regular visits to healthcare facilities.

Part of the problem lies in the implementation of the new system. As of October 2024, the government reported that over 12.7 million Kenyans had registered with SHA, including those who were previously covered under NHIF. However, there has been a lack of clear communication and education on how to navigate the new system, leading to confusion among both healthcare providers and patients.

Health Principal Secretary (PS) Harry Kimtai acknowledged that there have been challenges during the rollout but emphasized that the government is committed to ensuring that all Kenyans have access to healthcare services under SHA. Kimtai urged Kenyans to register and add their dependents through the SHA’s online platforms, noting that many had registered but failed to complete the process by including their dependents.

“Registration is a continuous process and is ongoing through the USSD *147# or web-based portal on www.sha.go.ke or www.afyayangu.go.ke. We have also noted that most beneficiaries are registering but not adding their dependents,” Kimtai said.

Ensuring No One is Left Behind

The transition to SHA represents a significant step forward in Kenya’s efforts to provide universal healthcare coverage. However, the government must ensure that the system is fully operational and accessible to all, particularly the most vulnerable members of society, like James Kanyore.

While the government has taken steps to address individual cases like Kanyore’s, a more systemic solution is needed to prevent similar situations from arising in the future. This includes improving communication about the new system, ensuring that healthcare providers are fully trained and equipped to handle the transition, and providing clear guidelines for patients who may not fully understand how SHA works.

Additionally, the government must ensure that the SHA is properly funded and resourced to meet the growing demand for healthcare services in Kenya. The success of the new system will depend on its ability to deliver affordable, accessible, and high-quality healthcare to all Kenyans, regardless of their income or location.

Conclusion

The story of James Kanyore serves as a powerful reminder of the challenges that can arise during major systemic transitions, particularly in healthcare. While the government’s move to refund the Sh9,500 Kanyore paid for dialysis is commendable, it’s clear that more needs to be done to ensure that no Kenyan is denied access to essential medical services due to bureaucratic hurdles.

As Kenya continues to transition from NHIF to SHA, the government must prioritize the needs of patients, particularly the elderly and those with chronic illnesses. By addressing the challenges head-on and ensuring a smooth and transparent transition, the SHA has the potential to significantly improve healthcare access for millions of Kenyans.