The Caucus of Patient-Led Organizations of Non-Communicable Diseases Call Upon the Government to Streamline SHA Operations

A recent survey by the Caucus of Patient-Led Organizations of Non-Communicable Diseases (NCDs) has uncovered significant challenges in the rollout of Kenya’s Social Health Authority (SHA) and Social Health Insurance Fund (SHIF), particularly affecting patients with chronic conditions like cancer, diabetes and cardiovascular diseases.

The survey, conducted on October 24-25, 2024, in Nairobi, Kiambu, Meru, and Bomet Counties, highlighted key issues including:

1. Access Delays & System Inefficiencies: Public hospitals are experiencing frequent delays due to system failures, making it difficult for patients to access critical services in a timely manner.
2. Limited Coverage in Private Facilities: Many private hospitals restrict SHIF coverage to civil servants, excluding a large number of NCD patients from essential care, leading to financial burdens from out-of-pocket expenses.
3. Lack of Specialized Care: Mission and public hospitals lack SHIF coverage for specialized treatments, particularly for rural patients, which prevents life-saving interventions like surgeries for NCDs.
4. Increased Financial Strain: NCD patients now face out-of-pocket expenses for services that were previously covered under the National Hospital Insurance Fund (NHIF), as well as uncertainties surrounding SHA benefits and unpaid NHIF debts.
5. Suspended Overseas Treatment: The suspension of coverage for overseas treatments has left many patients without options for specialized care unavailable within Kenya.
6. Limited Public Awareness: Many patients are unaware of SHA benefits, eligibility criteria, and premiums, which has led to confusion and frustration.

The Caucus urges immediate action to:

• Restore overseas treatment coverage for NCD patients.
• Clarify and publicize SHA benefit structures.
• Address system failures to reduce patient waiting times.
• Settle outstanding NHIF debts.
• Launch public awareness campaigns.
• Involve patient organizations in decision-making processes.

Evans Majau, Chair of the Caucus emphasized that SHA’s rollout has failed to meet the needs of patients with chronic diseases and called for transparency, access to specialized care, and patient-centered solutions to ensure the success of universal health coverage in Kenya.

The Caucus remains committed to advocating for an equitable healthcare system in the country.