In October 2023, Kenya’s healthcare system underwent a major change. The familiar National Health Insurance Fund (NHIF) was replaced by the Social Health Insurance Fund (SHIF). While this change promised better healthcare coverage for all Kenyans, the reality on the ground tells a different story. Take, for instance, Divinah Mokeira. She arrived at Mama Lucy Hospital, excited to welcome her third child. Instead, she found herself trapped in a nightmare. Despite having active insurance coverage, she was handed a bill for Sh 20,000 after just one day of care.
“I only had 1,500 shillings that I had carried to shop for my baby,” she recalls. Her family’s solution? Creating an emergency WhatsApp group for fundraising – a desperate measure that’s becoming increasingly common in Kenyan hospitals.
The crisis extends beyond maternity wards. In Nakuru, Salome Achieng’s emergency cesarean section turned into a financial ordeal. After being transferred between hospitals, she faced a staggering bill of Sh 47,000.
For patients with chronic conditions, the situation is more dire. Ann, speaking through social media, shared the heartbreaking loss of her father. He missed his dialysis sessions previously covered under NHIF but became inaccessible under SHIF.
A System in Distress
Popular gospel DJ Krowbar puts the crisis in stark terms: “I know of 6 people who died in October because they didn’t get dialysis on time.” These deaths, he explains, were directly linked to problems with the new SHIF system.
Intended to enhance universal health coverage, the shift has resulted in widespread frustration among patients, healthcare providers, and stakeholders. Despite repeated assurances from President William Ruto and Health CS Deborah Barasa that the system is efficiently serving Kenyans, the glaring failures and complications arising from the transition have raised urgent questions about accessibility, affordability, and the overall effectiveness of the new system.
Dr. Chibanzi Mwachonda, former Deputy General Secretary of Kenya’s Medical Practitioners Union, points to several critical issues. He laments that hospitals aren’t receiving timely reimbursements, adding that the new system was rushed without proper preparation.
Mwachonda argues that many facilities lack proper training and infrastructure.
“The hasty rollout is why it’s not working as promised,” Dr. Mwachonda explains. “To build trust, the government needs to be more transparent about these issues.”
Another challenge is the low registration rate for SHIF. Despite the mandatory transition from NHIF to SHIF, public resistance remains prevalent. There are about 20 million Kenyans who have now registered.
Informal sector workers, who comprise a large part of the Kenyan workforce, struggle with the financial requirements linked to mandatory insurance contributions. Dr Mwachonda pointed out, “If the government struggled to streamline efficiency in collecting NHIF contributions from the informal sector, how ready are they to manage SHIF’s contributions?”
The sentiment surrounding SHIF’s implementation has prompted religious leaders to call for its suspension, echoing widespread discontent. In a recent statement, these leaders assert that the government has failed to involve the public adequately in the transition process and argue that the benefits previously provided under NHIF have been reduced under SHIF. The clerics have raised serious concerns about financial burdens, transparency in fund allocation, and the disarray that has surfaced from the rapid implementation of the new scheme.
In light of these compounded challenges, experts emphasize several strategic interventions to address the issues surrounding SHIF. Dr Mwachonda advocates for the government to increase budget allocations, asserting that such funding is essential for SHIF to be sustainable and for timely health service obligations. Moreover, he noted, “I believe the government has not adequately thought through this aspect, and if they have, they’ve certainly failed to communicate the detailed framework to the public effectively.”
