Patients stranded in hospitals during chaotic SHIF rollout

Chaos, confusion, tears and hopelessness engulfed patients in hospitals, which disabled the National Health Insurance Fund (NHIF) before systems to support the new Social Health Insurance Fund (SHIF) were installed.

The first day of transition to SHIF rollout turned out to be a total disaster for patients and hospital administrators around the country.

Last evening before midnight, most health facilities including Kenyatta National Hospital, the biggest public referral hospital in the region, Kenyatta University Teaching, Referral & Research Hospital, Mathari National Teaching and Referral Hospital, Kakamega County Referral Hospital as well as The Nairobi West Hospital and many others discharged patient hours before the shutdown of NHIF systems.

According to hospital administrators who spoke to the Business Daily, they were hoping to re-admit the patients in the new SHIF system yesterday morning but to their shock and surprise the government up to now is yet to activate the new system it has been touting day and night since July 1 this year when registrations commenced.

Secondly, a memo from acting Social Health Authority (SHA) CEO Elijah Wachira seen by the Business Daily sent via email to all public and private health facilities is silent on the fate of patients who had been admitted under NHIF as the country moved to SHIF starting today.

A third reason hospital administrators give is that they do not trust the President William Ruto’s Kenya Kwanza government to reimburse them for services rendered during the transition and so they are not relying on memos and word of mouth in the media to provide their services without any legal binding document.

Speaking to Nation in an interview, Kapenguria County Referral Hospital medical superintendent Simon Kapchanga said they are grappling with major challenges as the new system is yet to be implemented plus they have not signed any contract with SHA.

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Dr Kapchanga pointed out that they are not allowed to handle some patients if they are not at Level 2 or 3 hospitals.

“They have not distinguished between comprehensive and non-comprehensive cover,” he said.

This is perhaps why thousands patients in public and private health facilities are stranded.

A nationwide spot-check by the Business Daily on Tuesday found that the Health ministry, counties as well as public and private health facilities are not ready for the transition from the 57-year-old NHIF to SHIF.

In fact, almost 80 percent of public and private health facilities are yet to complete their onboarding to SHIF with some disclosing to the Business Daily that they intend to finalise their partnership with SHIF soonest.

Hospital administrators also blame the State for the mess that has seen cancer patients who have been depending on their NHIF cards and are in dire need of chemotherapy and radiotherapy sent away from the facilities with some settling on ‘Fuliza loans’ to offset the vital treatments are now only being offered upon paying out of pocket.

“We have just been told to register patients and make sure they join SHIF, no further directions on things like billing or how to process claims when we take in patients. There is also no explanation or road map to do anything else apart from generating subscriptions. Honestly, after Kenyans subscribe, what next? We are in the dark,” said a senior hospital administrator who runs a government health facility in Kiambu County.

A second hospital administrator in Kakamega who admitted that they are even detaining expectant mothers who delivered as from 12.01am when NHIF went off last evening while agreeing with the Kiambu administrator said the county government has not equipped them with medical supplies to treat the patients who will now be forking out more money for what the government has since July 1 this year been peddling as quality service.

He is also of the view that Health Ministry seems to be only focused on driving up subscriptions which as of 29th September 2024 stood at 2,019,588.

On Monday while appearing before the Department Committee on Health led by Endebess MP Dr Robert Pukose, Health CS Dr Deborah Barasa said that their goal is to generate Sh148 billion from the new health scheme in a year as per health ministry predictions.

The money, she added, will be pooled and used to better the country’s healthcare system in the quest for universal health coverage for everyone, especially those who can’t afford.

At KNH in Nairobi on Tuesday, Elizabeth Nanjira (40), a mother of three who has been relying on NHIF went into labour at 12.20am last evening, twenty minutes after SHA was born.

She cannot afford to pay for maternity, is currently detained at the health facility until she pays out of pocket.

According to the KNH official website, normal delivery charges range from Sh55,000 which includes three days general bed ward service inclusive of specialist's charges.

“This government said it had brought Linda Mama initiative and had in fact made it bigger and better, I guess it was just another big fat lie from President William Ruto and his empty promises,” she opened up when Nation visited on Tuesday.

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Outside the gate at Pumwani Maternity Hospital, the situation was more less the same.

“My wife gave birth this week and is in there, they want me to pay in cash and considering the baby is in the newborn unit which needs it requires special provisions, I don’t know what to do.

But bless the newborn unit nurses at Pumwani because they are actually contributing out of pocket for baby formula and pampers, things which the government promised to provide,” Mr Dedan Kariuki told Nation.

“These are the things that makes a man sneak his wife and newborn out of a hospital, “the frustrated man added.

In Kakamega County where CS Barasa officially launched SHA on Tuesday, Norah Namboka, a trader said she was yet to understand why the government was shifting healthcare services from NHIF to SHA.

For example, Ms Namboka questioned why Kenyans were being asked to register a fresh yet their details can be obtained from the NHIF register.

“They would have picked the details from NHIF and shifted them to SHA instead of subjecting us to another registration process,” she added.

As per SHA acting CEO Elijah Wachira, their latest data shows that Kakamega is among the counties with low SHIF registrations.

He said that out of the 1.86 million people in Kakamega, only 27,000 have been registered with 2.37 million Kenyans so far having enrolled on the new health scheme as of September 30, 2024 (Tuesday).

In, Kisumu and Busia, at the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), tens of patients were stranded.

According to some of the hospital's junior staff who requested anonymity since they are not authorised to speak, the massive system failure resulted in delays in admissions, treatment and discharge of patients.

The facility was also not able to book theatre procedures with patients directed to wait or check with the hospital on Wednesday.
John Okello who had visited the facility to clear a pending hospital bill of a deceased relative explained that he had expected to offset the outstanding bill using the deceased's NHIF card but was unable to do so.

“I have been here since 9 am but I was informed that the system is still down and I come back after one or two days,” said Mr Okello adding that the delay is likely to affect their burial plans since they had scheduled to remove the body on Friday after clearing the bill worth Sh18,000.

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In Trans Nzoia, critical services that patients need have collapsed as many say they are yet to register with SHA.

“What the government has done us unfair because they could shift our details to the new fund so as to avoid service interruption,” a caregiver at Wamalwa Kijana Referral Hospital in Kitale said.

In Murang'a, Evans Manyeki (72) who on a monthly basis gets a mental health jab worth Sh100 using his NHIF card was turned away with instructions that he first gets registered into the new health scheme.

"Without the jab I become a wild animal and my family members usually panic since I become very irrational. This president William Ruto mess with the health sector wants to see me commit capital crime in my family...Despite paying for my health insurance, I have been forced to dig into my pockets to access the very service I had insured myself for," he lamented.

In West Pokot, expectant mothers expressed dismay as the ‘new look Linda Mama program’ benefits the government promised are nowhere to be seen.

“We are going to face a lot of challenges during delivery,” said Grace Cheptoo, an expectant mother at Psigirio health center.

In Kisii County, hundreds of patients at the Kisii Teaching and Referral Hospital condemned the long hours spent queuing while waiting to be processed with a hope of accessing services under the new health scheme.

“This thing is confusing. I came here at 10 am and it is now 3pm. I haven’t been processed. I am being told to wait but I don’t know for how long,” Peter Ogoti, a cancer patient said.

In Siaya, Jane Atieno (33) a business woman and a mother to a child living with sickle cell anaemia expressed uncertainty.

"My son has been relying on NHIF for treatment costs, will the new cover be similar to the one we have? I have already registered for the SHA but know very little about it," she told Nation.

In Homabay, Homa Bay County Teaching and Referral hospital is yet to adapt to the new health insurance programme.

Nation observed patients being given papers labeled ‘NHIF’ to fill in with a hope of accessing medical service.

The offices where hundreds of patients lined up are still labelled ‘NHIF’creating an impression that SHA is yet to start operations even among hospital staff.

In Bomet at Tenwek hospital, the inpatients who were due for discharge were barred from leaving the hospital because of NHIF preauthorization challenges after the old system was disabled throwing them into confusion.

A patient who had undergone a surgical procedure had incurred a bill of Sh 160,000 and was one of those who was due to be discharged from the hospital, but could not leave.

"We have been told that the NHIF has not authorised hospitals to process payments for pending cases of inpatients due for discharge.
We are stuck here yet we have been discharged. It is a very chaotic situation" Mr Nelson Cheruiyot, a care giver for the patient said adding that the option given by the hospital was to pay the balance of Sh 110,000 in cash with NHIF having paid Sh 50,000 on admission for surgery undertaken.

In Coast, implementation of SHIF was met with mixed reactions as some private hospitals declined the new cover.

Sidi Mwaringa, who is six months pregnant, had gone to a private hospital in Lamu Old Town was told that the facility had not yet received any communication or updates concerning whether to accept NHIF and how cash would be reimbursed by SHA.

"Last week, I was at the hospital with my NHIF card and I did scanning (ultrasound) and cash was deducted from my NHIF card. Today, I visited the same facility only for me to be told they have not been given a go-ahead to use the card. They said they were waiting for directives from SHA first before providing services using the card. I had to use cash to get services," said Ms Mwaringa.

In Taita Taveta county, administrators at a private hospital said they were only accepting civil servants to be treated under the new insurance cover.

An official at the hospital who requested anonymity said the information passed was that civil servants have an allocation in the national government budget.

This means that the hospital is not accepting the cards from any other group because they are not certain if or when the government would reimburse the payments.

Reporting by Leon Lidigu, Ouko Okusah, Angeline Ochieng, Stacy Atieno, Shaban Makokha, Wycliffe Nyaberi, Oscar Kakai, Evans Jaola, George Odiwuor, Vitalis Kimutai, Kalume Kazungu, Kevin Mutai, Wachira Mwangi and Lucy Mkanyika