Elijah Wachira, the Acting Chief Executive Officer of the Social Health Authority (SHA), has instructed all healthcare providers across the nation to persist in utilizing the insurance claims management system for patient admissions and discharges while they develop the new provider portal.
This recent announcement comes amid growing concerns for dialysis patients who previously depended on essential services provided under the National Health Insurance Fund (NHIF) at many private hospitals.
The shift to the new Social Health Insurance Fund (SHIF) has created significant challenges, leaving many patients in a state of uncertainty. The confusion stemming from the transition from NHIF to SHA poses serious risks to the health and wellbeing of Kenyans.
Seventy-six-year-old James Kanyori, a patient requiring dialysis, is a man filled with frustration. A representative from Citizen TV encountered him in Nakuru as he was on his way to a private medical facility for a lifesaving dialysis session. This was his second attempt that day. Unfortunately, the hospital was reluctant to provide him with the necessary dialysis, a service that he could once access through the now-defunct NHIF scheme. Kanyori left the hospital without receiving the critical care he needed, as he could not afford to pay for the service upfront. “I am being told to go find money, but I have no way to do that; at 76 years old, I have no means to raise cash. If I don’t get this treatment, I might not survive,” he lamented.
Florence Nyandieka, a dedicated caregiver, brought her husband to the hospital but had to spend Ksh. 8,500 for just one session of dialysis. To afford the cost, Nyandieka was compelled to sell two of her goats. Her husband, who requires dialysis twice weekly, creates a financial strain as the family struggles to gather the necessary funds for ongoing treatment. “I sold my goats, but if this continues, I don’t know what else I will sell; we are suffering under this government!” she exclaimed.
The Kenya Renal Association has expressed concerns, highlighting that the rocky implementation of the new SHA system has left dialysis patients in a precarious situation. “For the sake of our patients, we urge a more compassionate approach in handling these matters,” stated Jonathan Wallah, President of the Kenya Renal Association. Amid this challenging transition, hospitals are now required to admit and discharge patients using the Hospital Insurance Claims system that was in place prior to the rollout of SHA.
A letter from Acting SHA CEO Elijah Wachira to all healthcare providers in the country stated: “You are hereby informed that during the ongoing transition to SHA, you should continue utilizing the Hospital Insurance Claims system for admitting and discharging patients at your facility. This existing system will remain operational alongside the introduction of the new provider portal, which will be used for verifying and processing claims.”
This announcement follows Treasury CS John Mbadi’s acknowledgment that the Ministry lacks sufficient funds to fully support the rollout of SHA.
