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A month into the rollout of the Social Health Insurance Fund (SHIF), frustration is mounting among Kenyans and healthcare providers alike.

Many are voicing concerns that the chaotic start has jeopardised lives, though the government has portrayed SHIF’s first month as a success.

A closer look, however, paints a starkly different picture. Patients who need critical care, particularly those grappling with cancer and renal issues, are bearing the brunt of a chaotic implementation.

Though they had paid their contributions to the defunct NHIF, these patients now face potentially life-threatening delays in accessing essential medical services.

The Social Health Authority, the bureaucracy that administers SHIF, claims it has enhanced outpatient, inpatient and emergency care, as well as offers a robust cover for mental health care, critical illness and major surgeries.

Against this background, a new survey shows that the shift from the defunct NHIF to SHIF brings financial distress to private healthcare facilities due to delayed and insufficient payments. More than half of private facilities (50.8 per cent) have been receiving less than Sh100,00 from SHIF, according to the survey conducted by the Rural and Urban Private Hospitals Association between October 28 and October 31. The health providers say the money they receive is insufficient to cover operational

and payroll expenses. In Mombasa County, numerous healthcare professionals, especially those in public hospitals, are openly dissatisfied.

“Right now, no one really knows how [SHIF] is supposed to work. Officials insist it’s operational, but here on the ground, we’re struggling,” said a senior medic at Coast General Teaching and Referral Hospital. “Patients who need surgeries are stuck inwards because the portal rejects their applications.

They’re forced to pay in cash, which many can’t afford.” One major challenge, the medic explained, is that about 65 per cent of patients are paying out of pocket, creating backlogs and delays. “Cost sharing helped the health department for years, even before devolution.

NHIF was crucial — insurance coverage offset any bills. But now, people without insurance face significant upfront costs for surgery, metal plates, and other supplies.” The SHIF system issues are not confined to public hospitals.

‘At private hospitals across Mombasa, a drastic drop in outpatient numbers reflects the financial burden the insurance scheme places on patients, who previously enjoyed walk-in and walk-out services with NHIF.

Operational challenges

The SHIF rollout has been plagued by operational challenges, said Davji Atellah, the secretary general of the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU). “[SHIF] was rolled out urgently without ensuring the system was fully operational to guarantee access to care,” he said.

An attendant at Jambo Healthcare in Kongowea reported fewer patients, speculating, “Many seem to be treating themselves at home.” Patients, too, are increasingly vocal. Dennis Mambo, a registered SHIF member, shared his frustrations: “This month alone, I’ve spent over Sh7,500 on medical bills for my family.

My paycheck is already docked for [SHIF], yet I’m paying out of pocket.

What are we paying for if the services aren’t available?” George Onyango, from Mikindani, echoed these sentiments.

He said he had spent Sh17,300 on treatment for the persistent flu and rotavirus infection affecting his family.

“Healthcare is life and death. Why rush this rollout if it’s not ready? People are suffering, especially those who relied on NHIF,” Onyango said. The KMPDU Coast branch has also spoken out. Secretary Dr Ghalib Salim Ali dismissed SHIF as “a scam”.

He cited dialysis patients, saying they are only covered for one or two cycles a month when they need five or six. “Cancer patients authorised for one chemo cycle instead of several — where are we heading as a country?” he asked.