The chaos surrounding the implementation of the Social Health Authority (SHA) can be traced back to the government’s failure to implement a systematic phase-out of the National Health Insurance Fund (NHIF), a process that was recommended by the defunct NHIF board. According to the board’s exit report, had the two institutions been allowed to operate concurrently and phased out gradually, the transition to SHA could have been far smoother and more efficient.
The former NHIF board, chaired by Engineer Michael Kamau, emphasized the importance of thorough planning to ensure a seamless transformation of the healthcare system. They strongly recommended that SHA should be rolled out gradually, allowing for a more thoughtful and methodical transition rather than a sudden shift that has resulted in the current challenges.
The report highlighted the importance of giving the Transition Committee ample time to conclude its work before appointing a new Board, especially when it comes to sensitive areas such as healthcare. Transitioning these critical systems without enough time and foresight would inevitably lead to disruption. Furthermore, the board stressed that patient-centred activities should have been prioritized, with staff properly recognized for their role in the delivery of healthcare services.
The report reads: “There is a need to consider stakeholder input with a demonstration of either accepting or rejecting it with reasons. Technology should drive business and should be seamless. The two systems (NHIF and SHA) should have run parallel instead of having a direct changeover.”
The exit report also outlined several recommendations for improving the transition process, including the need for clearer laws and regulations, a focus on human resources and facilities improvement, and better financing for health services. These measures are seen as crucial in achieving effective healthcare delivery across all levels of the system.
The board’s concerns echo the frustrations voiced by patients over the implementation of SHA. Just last week, patients gathered at the Ministry of Health headquarters, expressing their anger over the delays and inefficiencies of the new system. Health Cabinet Secretary Deborah Barasa had just concluded a media briefing on the state of healthcare when patients, including Grace Njoki Mule and Diana Akoth, confronted officials to air their grievances.
Mule, speaking from the Kenyatta National Hospital (KNH), reported that more than 20 patients were waiting for services due to delays in SHA’s processing systems. “The system has been down since last Wednesday, and nobody seems to care,” she said.
Akoth, who recently underwent a Caesarean Section, said she was unable to access ultrasound and MRI services despite having paid all the required fees, including six months’ advance payment. “Without SHA approval, we can’t get any treatment. I’ve walked from KNH to SHA offices, trying to get help, but we’re still being denied services,” she added.
In its exit report, while the board acknowledged several milestones such as the successful verification of NHIF properties and improvements in records management, it raised significant concerns about budget constraints, staff shortages, and property maintenance issues. As of December 2023, the board reported that Sh25.48 billion was owed to healthcare providers, and the government owed NHIF Sh30 billion in outstanding premiums.
The report noted: “During the period, the Board followed up and held several meetings with the Ministry of Health, the National Treasury, and other key MDAs to realize the more than Kshs. 308 million owed to the Fund in outstanding premiums for enhanced schemes. The respective MDAs need to prioritize the settlement of these debts, which would ensure healthcare providers are paid promptly.”
The report also disclosed that NHIF had recovered Sh8.75 million defrauded from the fund by 12 hospitals through the Edu Afya Scheme. Despite this, challenges remain with biometric registration and e-claims systems, which have led to increased fraud and financial losses. In response, the board revamped biometric systems to include pre-authorization and claims processing, which has helped curb impersonation.
However, unresolved audit issues continue to plague the system. The report lists several pending cases, including disputes over the ownership of Karen land, a Sh1.4 billion architectural design cost for the Karen property, a Sh1.1 billion construction contract for the Cor Park project, and Sh49.5 million invested in Consolidated Bank, all of which are still under investigation or pending court rulings.
The report concludes by reiterating the need for a more thoughtful approach to healthcare transitions, underscoring the critical role of proper planning, stakeholder engagement, and sustained investment in human resources to deliver effective healthcare to the public.
