Patients denied treatment as SHA demands full payment
The Social Health Authority headquarters in Nairobi on March 18. The authority is demanding upfront payment of full annual premiums.
What you need to know:
- SHA Chief Executive Officer Dr Mercy Mwangangi promised to look into the matter.
- “I’m following up on this and on the system, after which I will give an update on Tuesday (today). But for now, kindly collect all these issues and share with me,” she said.
Thousands of Kenyans are being denied access to both inpatient and outpatient treatment after the Social Health Authority (SHA) began demanding full annual premium payments before providing care, a Nation investigation across ten counties has revealed.
The policy has left patients stranded at health facilities, forcing many to pay out of pocket or return home untreated, despite having previously made monthly contributions to the scheme.
In Embu County, Ms Pauline Nthiga, a community health extension worker who was among the 8,571 Universal Health Coverage medics hired by the government in 2020, stood in line at Embu Level 5 Hospital, visibly unwell.
Ms Nthiga, who was deployed to Covid-19 frontlines with promises of permanent and pensionable terms as well as gratuity but without medical cover, received a devastating text message: “Dear Nthiga, your SHA premium payment of Sh650 was rejected. Please pay a minimum of Sh7,150 to ensure full yearly coverage.”
Also read: Scandal of double SHA deductions
“I don't have the money and now I have no option but to go back home and just sleep because what else can I do?” Ms Nthiga said, tears streaming down her cheeks. “We have been living on peanuts. It’s so painful that I can’t afford to get the same medical services I give to humanity for a living.”
Child denied service
In Naivasha, near Longonot Police Station, Ms Maryanne Muthoni queued at ITARC Hospital with her sick child. After visiting various health facilities in Nakuru County, she was told that SHA was not paying for outpatient services in Level 4 hospitals, whilst one facility only accepted SHA for inpatients.
“I have been compelled to pay Sh2,550 out of pocket for consultation, tests and medication because SHA now demands that I must pay in full for annual premiums if I want my child to access their packages and be treated,” Ms Muthoni said.
“No one will touch your child if you don’t comply, so it leaves you with no option but to look for the money. But I'm thinking, what about other parents I have seen here who can’t afford and solely rely on SHA?” she asked.
Mr Moses Tune of Kilifi County recently lost his father who had undergone major surgery at Mephi Hospital, a Level 4 facility.
Displaying a text message similar to Ms Nthiga’s, Mr Tune revealed that SHA demanded he pays Sh10,200 as the full annual premium before they would even pay for a bed for his father.
Also Read: Former NHIF workers facing gloomy future
“His monthly premium was Sh850. Dad underwent an explorative laparotomy to remove a tumour in his colon, which was later confirmed to be colon cancer,” he said.
“It reached a point where dad complained of severe abdominal pains, so we booked for a physician review. Several examinations were done, but an abdominal CT scan suggested a mass on the large colon, so we went to seek a colonoscopy among other tests and paid Sh40,000 out of pocket,” he added.
The family was forced to hold a harambee to cover all the expenses.
In Nandi County last week, Ms Florence Janira slipped on a staircase and fell, fracturing her tibia and fibula—the two long bones in the lower leg.
“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,” Ms 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. I hope they find it in their heart to help me because most of my friends do not have money, while others told me they are surviving on Fuliza,” she said, referring to Safaricom’s money-lending platform.
Expectant mother turned away
Mr Israel Job from Kisii County described his experience with SHA as one he will never forget.
“I took my wife to Mosocho Level 4 Hospital last week, hoping she would receive the medical attention she urgently and desperately needed as she is expectant. However, what unfolded was both frustrating and disheartening,” he narrated.
“I was shocked when I was told I had to part with Sh7,200—an upfront annual payment of Sh600 per month for 12 months.
They explained that this was in line with a new SHA policy and without making this full payment, no services would be rendered.”
Mr Job explained his financial situation and asked if there was a way to make partial payments or access care while the registration process was underway, but he was turned away.
“We returned home, disheartened and still without the care my wife needed,” he said. “How can a system designed to serve the public turn away patients in need simply because they cannot afford to pay upfront?
The idea behind SHA may be well-intentioned, but its implementation appears to be deeply flawed and insensitive to the financial realities of ordinary Kenyans.”
He added that healthcare should be a right, not a privilege reserved for those who can afford lump-sum payments or navigate new policies on short notice.
“It’s heart-breaking to watch your loved one denied basic care because of bureaucratic barriers. As a citizen, I am left wondering: what kind of health system are we building, and who is it truly serving.”
Payment platform doesn’t work
Mr Job also tried using the Lipa SHA Pole Pole platform that the government has been promoting.
“They told us that if you dial *147# then go to the third column, you can pay slowly depending on your ability. But when I tried it, it redirects you to making a full SHA annual payment,” he said.
When contacted by the Nation, 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.
“I’m following up on this and on the system, after which I will give an update on Tuesday (today). But for now, kindly collect all these issues and share with me,” she said.
