SHA turns access to healthcare into pain and agony

 

The storming of Ministry of Health offices on Wednesday by angry patients from Kenyatta National Hospital highlighted the frustrations that thousands of Kenyans seeking health services under the new medical scheme have been enduring.

Frequent system outages and approval delays for services are some of the challenges clouding the implementation of the health scheme, denying patients easy access to treatment in several facilities across the country.

The situation has become so dire that patients seeking outpatient services have been forced to dig deep into their pockets to pay for services due to persistent system failures.

While Health Cabinet Secretary Deborah Barasa has issued an apology for the delays, blaming them on a system downturn that had lasted for days, the failure by the management of the Social Health Authority (SHA) to acknowledge or communicate these system failures raises fundamental questions about the authority’s commitment to delivering health services.

Speaking yesterday in Nairobi, officials from the Kenya Union of Clinical Officers, led by the chairperson, Peterson Wachira, stated that clinical officers are still unable to pre-authorise treatment or access necessary facilities on the SHA portal.

Any goodwill

The union has linked this to a clause under SHA that allows it to empanel facilities regulated by the Kenya Medical Practitioners and Dentists Council, under which clinicians work.

READ: Drama as patients storm Afya House over SHA failures

“However, the players who need to make decisions and implement them, particularly at SHA, have not shown any goodwill.

‘‘They have not implemented what was agreed,” Wachira noted.

The clinicians are set to down their tools from Monday next week, with their inclusion in SHA operations being one of the issues driving the industrial action.

Meanwhile, a spot check across several health facilities around the country has revealed that many patients are struggling to receive treatment in public facilities, despite enrolling in SHA and paying for services.

At the Coast, for example, a spot check across some public health facilities found that patients had not received treatment for the last three days due to system delays.

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

Child’s chest

“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) scan was required on her child’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 system failures.

Jumwa and Masha’s sentiments mirror those of most outpatients at the Coast.

Most patients said they had paid their monthly premiums and wondered why they were unable to access timely treatment.

Some said they travelled long distances daily to seek the unavailable treatment.

READ: SHA chairman talks about challenges in rollout

Kilifi County Health Executive Member Peter Mwarogo admitted that the system’s 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 extended beyond the county.

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

At the Coast General Referral and Teaching Hospital, the region’s largest facility, outpatients are still struggling to access medical services due to the system failures.

In the Rift Valley, several patients said they were still unable to access health services due to the system failures, leading to an uproar over the system’s effectiveness.

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

Public and private hospitals in Bomet County were struggling with the high number of patients who could not get services due to 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, staff at the hospital told us there was a technical problem with the SHA system,” Rugut said.

Josephine Too, from Kapkimolwa, who has a six-year-old child who was scalded, said she was told to register for Taifa Care for the child to be treated.

“I had not registered, but I was told to register and make the requisite contribution. The hospital began to take me in circles, claiming that the system was down, but when you send the money, the system worked. When it comes to service delivery, nothing happens. Where are we headed?” Too posed.

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

“We haven’t got help. We don’t understand why we’re being told to pay for SHA again. Some of us are poor. The government should help us,” he said.

However, patients at AGC Tenwek Mission Hospital 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 seen.

“It has been a challenge because the defunct National Health Insurance Fund (NHIF) had a lot of debt with us, running into millions, but we continue offering services,” she said.

However, some patients who spoke to The Saturday Standard said they are yet to understand the shift from NHIF to SHA, as well as the transfer process and the monthly contributions, some feel have been placed in the wrong category.

“Under NHIF, we used to pay Sh500 for low-income people like us. Now I’m being told to pay Sh750, and for my husband, it’s Sh1,030. SHA isn’t helping with outpatient services,” Justina Ruto, another patient, said.

The situation was similar 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 public hospitals said they were forced to send away a mother who had a child with a high fever because she could not access the portal.

Marion Wangui, a cancer patient at Nakuru Teaching and Referral Hospital, said she is sometimes forced to pay for drugs out of her pocket because SHA no longer covers medication, whereas she used to receive full treatment under NHIF.

“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]