Dying for treatment: How new health payment system is killing dialysis patients

Grace (not her real name) has cheated death three times a week for the past three years. Every Monday, Wednesday, and Friday, she arrives at one of Kenya's leading referral hospitals, where machines cleanse her blood of toxins her failing kidneys cannot filter. It's a routine that has kept her alive since her kidneys failed — until last week, when everything changed.

"They told me I must pay the full year upfront — over Sh10,000 — before I can get dialysis again," says the 44-year-old. "Where will I get that money? I can barely afford my monthly payments."

For three years, she religiously paid her Sh500 monthly contribution and received her life-saving treatment without incident. 

But the Social Health Authority's (SHA) new payment system has turned what was once a manageable healthcare arrangement into a death sentence for thousands of Kenya's most vulnerable patients.

A deadly ultimatum

Across the country, dialysis patients are being turned away from hospitals despite their previous monthly contributions, creating a life-or-death healthcare crisis. The government's shift from accepting monthly payments to demanding annual contributions upfront has left kidney patients facing an impossible choice: find money they don't have or slowly die from kidney failure.

The policy change has hit kidney patients particularly hard. Unlike other medical conditions that might require occasional treatment, kidney failure demands regular, expensive interventions that patients cannot postpone or skip.

Read: Why Kenya still records few kidney transplants and more dialysis

"Dialysis isn't optional for us—it's the difference between life and death," explains James Ochieng’, a 48-year-old father of three who has been on dialysis for two years. "I was paying monthly and getting my treatment. Now they want everything at once, money I simply don't have."

Ochieng’ can barely cover his treatment schedule as it is. His wife's small tailoring business barely covers their family's basic needs, let alone the Sh12,000 annual SHA requirement.

"Last week, I missed my dialysis session and already my legs are swelling—a sign that toxins are accumulating in my body," he says. "The hospital won't treat me without full payment."

The impossible mathematics of survival

The government's insistence on annual payments creates an impossibility for most Kenyans. While officials argue that annual payments improve cash flow and reduce administrative costs, they ignore the reality that most citizens cannot afford large upfront payments.

For dialysis patients, the consequences are immediate and life-threatening. Grace knows this all too well.

"I do not want to stop my dialysis because there was a time I had a financial crisis and never paid for my National Health Insurance Fund, and what followed was fluid overload and toxin accumulation. Within weeks, this becomes life-threatening," she explains.

"Missing dialysis sessions leads to rapid deterioration."

Ochieng's frustration is palpable: "It really bothers me that I have to struggle now, yet I have been paying. Why is the government not being considerate?"

Empty promises, desperate searches

The government has promoted the Lipa SHA Pole Pole platform as a solution, but patients report it doesn't work for their situation.

"If you dial *147#, it directs you back to the SHA payment portal for the annual payment," Ochieng’ says. "I will wait for them to do as they wish because it is now beyond me."

The crisis extends far beyond kidney patients. Reports from Naivasha, Nakuru, Meru, Nandi, Kisii, Mombasa, Kisumu, and Eldoret indicate patients are being turned away from facilities across the country.

In Nandi County last week, Florence Janira slipped on a staircase and fractured her tibia and fibula—the two long bones in her lower leg.

Read: New kidney dialysis technology offers patients better outcomes

"I went to Mbale County Referral Hospital for an X-ray. They put me in plaster and told me to pay annual SHA premiums of Sh5,500 for corrective surgery to be done," Janira told the Nation. "I do not have that kind of money and have no dependable source of income to raise it."

She returned home to fundraise, hoping well-wishers would help her. When we checked on her on Monday, she had not yet raised the money.

"I have been unable to sleep because of the pain. I can't take it anymore and have decided to go seek help at Jaramogi Oginga Odinga Teaching and Referral Hospital," she said. "I hope they find it in their heart to help me because most of my friends do not have money, whilst others told me they are surviving on Fuliza."

Healthcare providers caught in the middle

Healthcare providers find themselves trapped between their duty to care and the new payment requirements.

Dr Brian Lishenga, Chairman of the Rural and Urban Private Hospitals Association, explains the dilemma: "The hospitals may want to give services, but without the reflection of annual payment from the patient's side, they risk not being paid."

"All these being introduced, and then we leave patients on their own is not right. We will not be blaming hospitals because they also have to adhere to certain rules by SHA. Let's just make life of patients easy. We are not helping by coming up with ideas every day, which puts their health at stake," Dr Lishenga said.

Official responses fall short

Government officials have acknowledged the crisis but offered little concrete action. Last week, Medical Services Principal Secretary Ouma Oluga said: "We will address all concerns. Keep a collection of all of them."

SHA Chief Executive Officer Dr Mercy Mwangangi promised to look into the matter, even as patients continue to suffer.

"I'm following up on this and on the system, after which I will give an update on Tuesday," she said. "But for now, kindly collect all these issues and share with me."