Grace Mulei, a patient, from Kenyatta National Hospital, storms Afya House, Nairobi to register her disappointment with SHA on January 15, 2025. [Jenipher Wachie, Standard]
"I am pleading with the government to improve the SHA scheme. As a cervical cancer patient, I went through chemotherapy when NHIF was working, but today with SHA, I have to buy some drugs," said Wangui.
Phoebe Ongad, the executive director of the Kenya Network of Cancer Organisations, said the SHA scheme is only good on paper, but in reality, patients are suffering because they cannot access services.
"SHA looks good on paper, but patients are suffering. Initially, patients had a cap of Sh600,000 with NHIF, which would cover radiotherapy, chemotherapy, and surgeries, but SHA scraped it off," Ongad said.
In Trans Nzoia, patients battling chronic illnesses complained about the inaccessibility of essential services, citing the failure of SHA approvals.
Adelight Okumu, a mother of one from Sitikho village in Kwanza Constituency, said she has been unable to access treatment under SHA. Okumu suffers from a debilitating nerve disease and muscle atrophy, leaving her unable to walk or bend.
"SHA is supposed to be universal, but it is not accepted in private facilities where specialised care is available. I have resorted to searching for treatment online and buying medication without a doctor's guidance. It's risky, but I have no other choice," Okumu said.
She says she frequents physiotherapy sessions to help her regain speech, but SHA does not approve payments.
Okumu's mother, Hellen Okumu, expressed her frustration, saying she has no means to support her daughter's medical needs.
"We are poor, and without this insurance working, I cannot afford private hospital charges. I am appealing to well-wishers to step in and help us. My daughter is suffering, and there's little we can do," she said.
She added that SHA was introduced to improve healthcare access, particularly for vulnerable groups. However, its ineffectiveness in covering private health facilities has left many stranded, especially those who require specialised care unavailable in public hospitals.
Self-medication
Community health advocate James Omaria called for immediate intervention, stating that the programme's failure is a betrayal to patients who depend on it.
ALSO READ: MPs: Chaotic rollout of SHA adds more pain to patients
"The government needs to address this issue urgently. People are being forced into dangerous self-medication or abandoning treatment altogether," Omaria said.
A spot check by The Standard in Kakamega County revealed that some patients are still struggling to get services on time due to delayed approvals.
Jane Nekesa, a parent with a patient at Kakamega General Hospital, said she is unable to foot the Sh45,000 medical bill she is required to pay after being told SHA cannot cover the cost of an intramedullary rod following an accident.
"I was told to register with SHA when my son had an accident and I did so. My child was admitted, and I was told to pay Sh8,000 for a year as a premium. Shockingly, I was told SHA cannot cover the Sh45,000 medical bill after it was recommended that he be fitted with an intramedullary rod on his leg," said Nekesa.
"During registration, it took a day to get registered, and my son was attended to the next day. These are some of the issues many people are facing, in addition to the high contributions to the scheme."
Kakamega County Executive Committee Member Peninah Mukabane acknowledged the issue of system failure, despite recording success stories from patients across the county.
At Janeiro Hospital Level Four in Homa Bay, administrator Jeremiah Jalang'o said they had experienced system problems.
"At times network failure occurs during pre-authorisation for surgery," Jalang'o said.
[Report by Maryann Muganda, Kiprono Kurgat, Hilda Otieno, Willis Oketch, Marion Kithi, Benard Lusigi, Martin Ndiema, Anne Atieno, Nikko Tanui and James Omoro]