Teen mothers left stranded as SHA maternity cover falls short

A section of the SHA building located at Upper Hill in Nairobi. [Edward Kiplimo, Standard] 

Despite the government’s repeated assurances that maternity services are accessible to vulnerable mothers, teenage mothers are increasingly finding themselves stranded in hospitals because of unpaid bills.

Whereas the government has continuously insisted that teenage mothers are automatically enrolled and receive free antenatal care, delivery, postnatal care and psychosocial support under its health financing system through the Social Health Insurance Fund (SHIF), the reality on the ground appears to be different.

Most of the affected mothers are those who have not registered with the Social Health Authority (SHA) due to financial constraints, those without national identity cards or foreigners married to Kenyan husbands who are yet to formalise their papers.

As some politicians move to exploit the mothers’ desperation by settling their bills for political gain, county governments have also been forced to intervene by waiving the outstanding charges.

In Kiambu County, Thika Town MP Alice Ng’ang’a, who is also the chairperson of the National Assembly’s Social Protection Committee, has been making high-profile visits to county hospitals to demand the release of mothers unable to settle medical bills.

Her recent visit to Ruiru Hospital, accompanied by bloggers and content creators, focused on mothers awaiting approval of bill waivers.

Critics argue that instead of such interventions, the MP should push for the restoration of Linda Mama, which previously supported maternity services for vulnerable women.

The absence of the programme has also been linked to poor access to prenatal and postnatal care, raising concerns over maternal health outcomes.

Former Health Cabinet Secretary Sicily Kariuki blames the government’s decision to remove programmes targeting specific groups such as Linda Mama and Edu Afya for the confusion.

“During our time, the national government had set aside specific funds for Linda Mama that were channelled through the defunct National Health Insurance Fund (NHIF). What an expectant mother required to access the facility was paying Sh50 for registration,” she says.

“It is a disgrace to see young mothers being detained in hospitals over bills while others lose their infants. The government needs to come up with a more realistic solution,” Ms Kariuki said.

Ms Kariuki says that though the government appeared to expand the maternal services under the Taifa Care program, the move has not been of much help to expectant mothers and has instead discouraged mothers from going for prenatal care.

In many cases, the teenage mothers, mostly from poor backgrounds, have been forced to sleep on cold hospital floors for days as their families desperately seek ways to raise the money, including through fundraisers and the sale of whatever property they can afford to part with.

“Cases of mothers being detained in hospitals over bills after delivery are apparently on the rise, despite the government’s repeated assurances that the Social Health Insurance Fund (SHIF) caters for everything, says Lawrance Omondi, the executive director of Machozi Ya Mwisho Initiative, a non-governmental organisation that campaigns against new mothers being detained in hospitals over unpaid bills.

According to Omondi, the NGO has been receiving several calls from mothers and family members in distress from all over the country, with the most recent cases being from mothers who had been detained at Eldoret-based Moi Teaching and Referral Hospital and Nairobi’s Mama Lucy Kibaki Hospital.

Omondi says his organisation has been called upon to rescue mothers detained in hospitals in Busia, Kisumu, Lamu, Mombasa, Kitui, Kiambu, Machakos, Nakuru, Kakamega, Bungoma, Baringo, Uasin Gishu and Isiolo among other counties.

Late last year, Mama Lucy Kibaki Hospital was in the headlines for the wrong reasons when former Nairobi governor Mike Sonko intervened to clear an outstanding bill of Sh1.6 million for 110 mothers who had been detained at the facility. Many of the mothers had not registered with SHA.

‘’My office receives several distress calls from mothers detained in various hospitals across and we have intervened by paying their bills. The issue has now become a big problem that is now overwhelming us,” Sonko told the Standard.

Sonko says the cases at Mama Lucy Kibaki highlight the difficult transition from Linda Mama, which provided free maternity services in public facilities, to the current SHA system.

While Governor Johnson Sakaja dismissed claims of detention, explaining that the delay in discharging the mothers was part of processing formal bill waivers through the county committee, the hospital’s CEO, Fredrick Obwanda, contradicted him, claiming the facility was protecting its financial sustainability as unpaid bills caused major operational strain.

“We were staring at the possibility of losing about Ksh10 million in seven days. The only solution to this challenge is to register for social health insurance,” Obwanda said yesterday.

Sometimes back, a video of 27 teen mothers detained at the Moi Teaching and Referral Hospital over bills ranging between Sh20, 000 and Sh500, 000 narrating their harrowing ordeal at the facility, went viral.

Though the hospital’s CEO, Dr Philip Kirwa, denied claims of illegal detention and mistreatment, blaming the issue on the mothers’ lack of IDs and birth certificates that made SHA unable to process their claims, the mothers accused the facility of demanding payment before they could be released.

In Kiambu, which is one of the counties that has recorded high cases of mothers failing to clear their bills, the Committee Member for Health Services, Dr Elia Maina, says the devolved unit spends over Sh100 million annually on waivers in the maternity section to mothers who are unable to pay bills.

According to the County Executive Committee Member for Health Services in Kiambu County, the county government has been issuing waivers worth over Sh100 million in the maternity section to mothers who are unable to pay bills.

During the 2025/2026 financial year, Kiambu Level Five Hospital waived more than Sh20 million in bills, while Thika Level Five Hospital, in one instance, was forced to waive bills totalling Sh15 million.

Public and private hospitals in Kiambu County treated approximately 5.4 million inpatients and outpatients, including those from neighbouring counties.

Dr Maina says the county, which boasts of 119 hospitals, including three level five hospitals and 14 level four hospitals, receives patients both from within the region and from neighbouring counties such as Nairobi, Murang'a, and Machakos.

And because hospitals are public facilities, Dr Maina says, no patient is turned away, even if they lack funds or medical cover.

“That is why you realise those women who say they have been unable to pay their bills first appear to have been treated and taken care of well, but their challenge is money,” Dr Maina said.

 Dr Maina says the waiver process, however, takes time before it is implemented, since it involves vetting the patients through the social worker’s department to ascertain their inability to pay in order to avoid misuse of the process.

“You cannot just say that you have delivered and do not have money to pay and get the waivers automatically. You have to be investigated so that these waivers are not abused by people who can pay,” he says.

Kiambu County Assembly Majority Leader Godfrey Mucheke, who is now serving his second term, says that during the previous administration under President Uhuru Kenyatta, counties received funds from the national government as reimbursements for maternity bills.

He says that while the detention of mothers in hospitals over pending bills is a nationwide crisis, in Kiambu it has been hijacked by some individuals as a political tool, with some MPs using it to taint healthcare services.

This, he says, has caused the county to incur losses by releasing even people who don’t deserve waivers.

“What is annoying is that some MPs, where laws and policies are made, are storming our hospitals with cameras and microphones to politicise the issue of mothers unable to pay bills and fuel propaganda against the governor. The moment those MPs storm the hospitals, they force all mothers in maternity wards to be released. They should be pushing the national government to bring back Linda Mama,” Mucheke said.

Public and private hospitals in Kiambu County treated approximately 5.4 million inpatients and outpatient service seekers last year, indicating a growing influx of patients from neighbouring counties who stream to county facilities for healthcare services.

In Kitui, former governor Charity Ngilu has raised concerns over the detention of patients at Kitui County Referral Hospital over unpaid medical bills. During an unannounced visit to the facility on September 6, Ngilu toured the maternity wing and questioned the conditions facing mothers and newborns.

She alleged that as many as four mothers and their babies were sharing a single bed, while the hospital faced shortages of essential medicines and medical supplies.

Ngilu also said she encountered teenage mothers who had remained at the hospital for up to three months after failing to clear their bills.

She questioned why patients were being held at a facility meant to save lives.

But when contacted, Health Cabinet Secretary Aden Duale, while discounting reports of mothers being detained in hospitals over bills, said the government has been ruthlessly dealing with facilities doing that, including deregistration.

“Can you share specific hospitals if there are any? Teenage mothers are covered by SHA automatically and there is no requirement for one to have an ID. All the other stories about mothers being detained are propaganda,” Duale said.

In Busia, county deputy governor Arthur Odera, who also doubles up as the CEC for health, blames the new mothers’ agonies in hospitals on multi-dimensional issues that range from poverty levels, lack of national IDs, and patients from neighbouring Uganda.

“Poverty levels in this country are quite high to such an extent that millions of families cannot raise lump-sum money for upfront payment as demanded by SHA. This has left several mothers vulnerable and forcing them to avoid prenatal clinics,” he says.

Odera also says there are cases of jobless teenagers and single mothers who fail to inform their parents after conceiving and instead run away from their homes to seek refuge elsewhere.

 “The majority of the cases of mothers being detained over bills are teenagers. It is a delicate situation that forces counties into waiving the bills,” Odera says.

Odera says since hospitals have to mind their financial sustainability, they can’t rush into waiving bills.

“We have a very vigorous process that includes vetting and assessing families’ financial situations to seal loopholes that could be used by individuals out to take advantage,” Odera says.

Two weeks ago, in Kirinyaga, former Woman Representative Wangui Ngirici paid a bill of Sh15, 000 to secure the release of a mother who had spent a month at Kerugoya County Referral Hospital.

Susan Njeri had remained at the hospital’s maternity wing after giving birth, unable to raise the outstanding bill. Ngirici’s team said it intervened to settle the bill, allowing Njeri to leave the facility with her newborn.

Ngirici, who is seeking the Kirinyaga governorship in the 2027 elections, pledged to introduce free maternity care if elected. She also promised to establish a Kirinyaga Healthcare Card to help reduce the burden of medical bills on families

On the issue of teen mothers, Omondi recalls an incident last month when several young mothers remained detained at Makueni Mother and Child Hospital after giving birth because they could not afford to settle their medical bills.

Among them was a 17-year-old Form Four student from Kitonyoni, Kathonzweni, who had developed complications during labour on August 16, 2026.

After a nearby health centre was found closed, her family rushed her to a private hospital, where she delivered and paid Sh12,000. However, complications affecting her and the baby forced their referral to Makueni Mother and Child Hospital the following day.

The baby was admitted to the Newborn Unit while the mother was treated in the general ward. Although both were eventually discharged on September 4, they remained in the hospital over an outstanding Sh31,700 bill.

The girl's mother, Sabina Kangwiria, recounted how she had slept outside the hospital because she could not afford accommodation while seeking help to clear the bill. She also disclosed that her daughter was due to sit her KCSE examinations this year.

Another 19-year-old mother from Mutanda village, Mbooni, had also been detained after giving birth to a baby girl. She owes Sh14,850 despite being discharged last week.

Makueni Chief Health Officer Dr Harvey Mbithi, however, denied being aware of the cases but promised to investigate and facilitate the teenagers’ release.

However, when contacted for comment, Mombasa governor Abdulswamad Shariff Nassir, who is also the chairman of the Council of Governors’ (CoG) committee on health, while denying claims of mothers being detained over unpaid bills, said SHA caters for all maternal patients in levels 2 and 3 hospitals.

“As long as one is registered with SHA, all the bills arising from prenatal, birth and antenatal are taken care of. I don’t understand why one would seek medication in levels 4 and 5 for services catered in levels 2 and 3. Those going to such facilities should be ready to meet the expenses,” Nassir said.