A month after the Social Health Authority (SHA) was rolled out, the system has hit a number of milestones as well as experienced a number of challenges.
According to the Ministry of Health, SHA has processed services worth around Ksh 2.6 billion within the last 37 days, covering essential healthcare needs like maternal and child health, dialysis, mental wellness, and oncology.
Moreover, registered members can now access free primary healthcare at Level 2 and 3 facilities countrywide, making healthcare more accessible to millions of Kenyans.
However, all this hasn’t come without a share of challenges. In a televised discussion on Citizen TV, some CEOs of the country’s leading public hospitals have voiced some of these hits which have made significant improvements in healthcare services as well as some misses.
While they acknowledged the early challenges of transitioning from the National Health Insurance Fund (NHIF) to SHA, the CEOs agreed that the new system is proving beneficial for patients and hospitals alike including;
1. Faster Preauthorization for Admission and Medicare Access
Under the NHIF, patients often faced significant delays in receiving preauthorization for treatments, sometimes waiting as long as seven days before approval was granted.
The extended waiting times led to considerable stress for patients and delayed treatments, especially for those with urgent medical needs. However, the SHA system has dramatically reduced the preauthorization period to as little as four minutes.
Dr. Richard Lesiyampe, the CEO of Jaramogi Oginga Odinga Teaching and Referral Hospital, emphasized the impact of faster preauthorization noting, “We’ve seen immediate improvements in patient access, with preauthorizations dropping to a fraction of what they used to be. This quicker response time reduces backlogs and allows patients to receive the care they need without unnecessary delays.”
Dr. Evanson Kamuri, CEO of Kenyatta National Hospital (KNH), echoed these sentiments, stating that the quicker preauthorization helps them avoid service congestion, ensuring that treatment starts as soon as possible. This change benefits not only the patients, who experience faster service, but also healthcare workers, who face less bureaucratic pressure.
2. Emergency Care Without Upfront Payment
Previously, there have been many cases of unconscious patients or accident victims being required to provide a cash deposit before receiving medical attention, leading to potentially life-threatening delays.
Now, SHA’s Emergency, Chronic, and Critical Illness Fund (ECCIF) has stepped in to emergency cases, ensuring prompt treatment for patients in critical need.
Dr. Philip Kirwa, CEO of Moi Teaching and Referral Hospital, spoke to the relief that SHA brings to accident victims and emergency cases:
“This is going to have a major impact on the society. For instance for patients who come in with emergencies, we do treat them irrespective of whatever payment they have. We know from SHA the patients will be managed through ECCIF (Emergency, Chronic, and Critical Illness Fund) which gives dignity and ensures they get appropriate services.”
Health CS Deborah Barasa during a visit to Kenyatta National Hospital to assess the facility’s performance under SHA
The ECCIF fund, a key component of SHA, addresses financial gaps in emergency care, covering services when patients cannot immediately pay.
3. Increased Resources for Public Hospitals
According to the medics, SHA is not only improving patient experiences but is also proving to be a boon for hospitals. Unlike NHIF, SHA provides higher compensation rates to public hospitals, which can reinvest these funds into improving healthcare delivery as explained by the hospital bosses.
Dr. Kirwa noted that the additional funding from SHA is helping them purchase new equipment, improve facilities, and invest in personnel training.
4. Efficient Access to Services Without Waiting Periods
For Kenyans who have experienced the frustrations of NHIF’s waiting period, SHA brings welcome relief. Under SHA, as soon as a person completes the registration process and makes the necessary payment, they are immediately eligible to access healthcare services.
This is a sharp departure from NHIF, which required a waiting period before new members could access certain services.
“Increasing hospital resources will have a long-term impact on the quality of healthcare we provide,” Dr. Kirwa said. “More funding means better equipment, a safer and more comfortable hospital environment, and more staff training, which will ultimately raise healthcare standards across the country.”
This enhanced funding model allows public hospitals to expand their infrastructure, purchase modern diagnostic equipment, and offer comprehensive patient care.
According to Dr. Kamuri, the seamless registration-to-service process has been a major improvement:
“The people who have now tasted the system are really happy about it. It has helped us in terms of time taken for one to register and start accessjng services. That has really shortened and improved efficiency. Transition has its own challenges but it’s now better compared to NHIF.”
5. Government-Assisted Care for Vulnerable Patients
One of the most progressive aspects of SHA is the assurance of healthcare for all, regardless of ability to pay. In the past, many patients faced extended stays at hospitals because they couldn’t pay their bills upon discharge.
This led to hospitals holding patients until payments were settled, which burdened both patients and healthcare facilities. SHA addresses this by providing coverage for vulnerable groups who may be unable to pay for premiums or medical services.
Dr. Kirwa shared that a significant portion of their patients are likely to have their bills waived due to inability to pay, but with SHA, these individuals will now receive support:
“A large number of our patients, usually around a third will end up not paying and you’ll end up waving, but we know SHA is going to help and everybody will have access to healthcare irrespective of whether you have money or not.”
According to the Jaramogi and KNH CEOs a few problems have equally been experienced during the transition period such as system hitches, shortage of resources, confusion on patient’s side etc.
“In the first days we had challenges of members being unable to register on their own, lack of gadgets to register patients, patients who hadn’t registered on NHIF anting to transit to SHA, challenges with preauthorization etc. However, most of these issues have been dealth with,” Dr Lesiyampe noted.
So far around 13 million have registered with several hospitals already being enrolled including 4583 public/govt facilities, 2500 private facilities, 548 faith-based facilities and 17 community centres.
