Health CS Barasa apologises for SHA system breakdown

The Ministry of health has acknowledged and apologized over system failures with the Social health Authority, which have disrupted provision of healthcare services in the country.

Speaking during an impromptu tour of the Kenyatta National Hospital yesterday, Health Cabinet Secretary, Deborah Barasa, said such interruptions, while regrettable, are not uncommon globally. “The incidents occurred on January 14th and 15th, temporarily disrupting some services such as patient clearance and billing,” she explained, adding,“to our patients, we are deeply sorry for the disruption. Your well-being is our priority, and we are working tirelessly to ensure consistent, high-quality healthcare.”

The backlog caused by the downtime has since been addressed citing that patients are receiving services.

The visit followed the storming of her Afya House offices by frustrated Kenyatta National Hospital (KNH) patients, who were calling for the return of the national health Insurance Fund system, which is now defunct. Some of the patients claimed that they were experiencing challenges accessing health services, yet the authority’s payment platform was still receiving money from Kenyans.

Hours after the patients’ protest, KNH issued a statement signed by the Chief Executive Officer, Dr Enanson Kaimuri, owning up to delays which it blamed on system downtime, but had since been restored.

 “The Social Health Authority system is now fully operational and aligned with the KNH system,” Dr Kamuri noted.

Meanwhile, patients from various parts of the country have been speaking of their exasperation with SHA systems.

A spot check in various health facilities indicate a sad reality.

So bad is the situation that patients seeking outpatient services have been forced to dig deep into their pockets to pay for services due to persistent system failures.

A spot check across several health facilities around the country established that several patients are struggling to get treatment in public facilities despite enrolling to the system and paying their packages.

At the Coast for instance, a spot check across some public health facilities established that some patients have not received treatment for the last three days due to delays in the system.

At Kilifi Referral Hospital, Ms Jumwa Kenga said her son developed chest complications on Wednesday and had not been treated because of the SHIF system failure.

“I was at the hospital yesterday, but I couldn’t get services because the system was down. I had to go back home, and now we have been told to wait a little longer,” said Jumwa.

Jumwa said a Magnetic Resonance Imaging (MRI) was to be performed on the kid’s chest for medication to be prescribed. “I fear that if the situation persists, his condition will worsen,” she said.

Duncan Masha said he developed body pains on Tuesday and had not been treated because of the SHIF system failures. Jumwa and Masha’s sentiments mirror the stories of most outpatients on the Coast.

Many of the patients said they had paid monthly premiums, and wondered why they were unable to access timely treatment. Some said they travel long distances daily to seek the unavailable treatment.

Kilifi County Health Executive Member, Peter Mwarogo, admitted that the systems’ frequent failure has affected health services in the county.

“Since last week, we have been experiencing downtime moments with the system. Sometimes it’s working, and sometimes it’s not,” said Mwarogo, adding that the problem was beyond the county.

In addition, Private medical facilities onboard in the county have also been accused of denying services to locals registered under the SHIF scheme leading to congestion in public hospitals.

At the coast region’s largest referral hospital, Coast General Referral and Teaching Hospital (CGRTH) in Mombasa, outpatients are still struggling to get medical services due to the failure of SHIF systems.

In the Rift Valley, several patients said they are still unable to access health services due to the system failure, leading to uproar over the effectiveness of the system.

More patients were forced to dig deep into their own pockets to pay for treatment after either being placed in the wrong category or lack of funds.

Public and private hospitals in Bomet County were struggling with the high number of patients who could not get services following technical challenges with the system.

The Standard visited Longisa and AGC Tenwek Mission Hospitals where hundreds of patients were left stranded and frustrated.

Joseph Rugut, a hypertension patient, expressed his frustration after being told the system was down despite paying his monthly contribution.

"Imagine we have been waiting since 8 am but when it came to our turn the staff at the hospital told us there was a technical problem with the SHA system," Rugut said.

Ms Josephine Too from Kapkimolwa who has a six-year-old child who was scalded said she had not registered and she was told to register for Taifa Care to get treatment.

"I had not registered but I was told to register to get services after registering and paying the requisite amount. The hospital started to take me in a cycle claiming that the system was down but when you send the money the system works but when it comes to service delivery things are opposite, Where are we headed? Too posed.

Another patient Geoffrey Rotich, a diabetic patient who was in the queue said he came early but he has not been attended to.

"We haven't got help. We thought SHA covered this, but we don't understand why we're being told to pay again with SHA. Some of us are poor. The government should help us,"

However, AGC Tenwek Mission Hospital patients were being attended to.

A nurse at the hospital, who declined to be named said despite the challenges with the SHA system patients are being attended.

"It has been a very big challenge because the former NHIF had a lot of debt with us, ranging in the millions but we continue offering services," she said.

However, some patients who spoke to the Standard at the hospital said they are yet to understand even the basics of the new system, such as transferring from NHIF to SHA and the monthly contributions, which some feel have been placed in the wrong category.

"Previously, we were told to pay Sh 300 for lower-income people like us. Now I'm being told to pay Sh 750, and for my husband, it's Sh 1,030 which is why we have to pay cash to get services. This SHA thing is troubling us and isn't helping with outpatient services," Justina Ruto, another patient noted.

The story was the same in Nakuru County where most patients were unable to receive treatment in most health facilities because they could not access the SHA portal.

A nurse in one of the government hospitals said they were forced to send away a mother who had a child with a high fever because she could not access the SHA portal.

Marion Wangui, a cancer patient at Nakuru Teaching and Referral Hospital, said she is sometimes forced to buy drugs from her pocket because SHA no longer covers them yet she would receive full treatment when NHIF was working.

"I am pleading with the government to improve SHA insurance. As a Cervical Cancer patient I went through Chemotherapy when NHIF was working, today with SHA, I have to go into my pockets to buy some drugs that we are told are not available at Cancer Treatment yet NHIF used to pay for us centers, “said Wangui.

Pheobe Ongad, who is the Executive Director of Kenya Network of cancer organizations, said the SHA program is only good on paper but in actual sense patients are suffering because they cannot access health care.

“SHA is only beautiful and looks good on paper but in actual sense, patients are suffering. Initially, our patients had a cap of Sh600, 000 with NHIF it would cover Radiotherapy, chemotherapy, and surgeries, but SHA scraped it off,” Ongadi said.

In Trans Nzoia, patients battling chronic illnesses complained over the inaccessibility of essential healthcare services, citing the failure of the SHA insurance program as a critical barrier.

Adelight Okumu, a mother of one from Sitikho village in Kwanza Constituency, says she has been unable to access treatment under SHA's Social Health Insurance Fund (SHIF).

Okumu suffers from a debilitating nerve disease and muscle atrophy, leaving her unable to walk or bend.

“SHIF is supposed to be universal, but it doesn’t work in the private facilities where specialized care is available. I have resorted to researching treatments online and buying medication without a doctor’s guidance. It’s risky, but I have no other choice,” Okumu said.

She says she has to attend to frequent physiotherapy sessions to enable her regain speech but SHA did 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 fees. 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 said 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 specialized care unavailable in public hospitals.

Community health advocate James Omaria called for immediate intervention, stating that the program’s failure is a betrayal to patients who depend on it.

“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 established that some patients are still struggling to get services on time with delayed approvals.

Jane Nekesa, a parent with the patient at Kakamega General Hospital said she is unable to foot the Sh45,000 medical bill she is required to pay after she was told SHA cannot cater for intramedullary rod following an accident.

"I was told to register with SHA when my son got into an accident and I indeed registered and my child was admitted. I was told to pay Sh8,000 for a year as a premium and shockingly I was told SHA cannot cater for the Sh45,000 medical bill after it was recommended that he be fitted with an intramedullary rod on his leg," said Nekesa.

“During the registration, it took a day to get registered and my son was attended to the next day and these are some of the things many people are going through besides high premium by people who are literary poor like me.”

Kakamega County Executive Committee Member (CECM) 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, the administrator, Jeremiah Jalang’o said they had experienced the problems.

“At times network failure occurs during pre-authorization for surgery. Registration for SHA also sometimes becomes impossible due to network failure,” Jalang’o said.

 Additional reporting by Kiprono Kurgat, Hilda Otieno, Willis Oketch, Marion Kithi, Benard Lusigi, Martin Ndiema, Anne Atieno, Nikko Tanui and James Omoro