e-Citizen: Double jeopardy for patients in public hospitals

Long queues at the Coast General Teaching and Referral Hospital in Mombasa as the Government rolls out e-Citizen Payment System to all State-owned facilities in this photo taken on February 5, 2024.

Photo credit: Kevin Odit | Nation Media Group

Olamayiani Naserian has dutifully visited the Kenyatta National Hospital oncology clinic since his wife was diagnosed with breast cancer last year. The 460-kilometer round trips from Oloitokitok to KNH are emotionally and financially draining, but they are the only hope for survival for the relatively young couple.  

On Wednesday, February 7, the Nation caught up with Mr Naserian (not his real name) and his wife who had visited for their cancer treatment at Kenyatta National Hospital. They had visited the national referral hospital the previous day, but his wife could not be treated as there was evidence that they had paid for the service on the e-Citizen paybill number, 222222.

“I made the payment around 1 pm on Tuesday, but I only received a confirmation message later that evening. Thereafter, I received a call from the hospital that the money had reflected (on my e-Citizen account) and that we should proceed with treatment. We came today but, unfortunately, the radiotherapy machine has broken down. we have to wait,” said Mr Naserian, while requesting that we do not disclose his real names to avoid jeopardising his chances of accessing the life-saving treatment. 

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“The government should not introduce such (the eCitizen single paybill) in hospitals, we will lose more people just because of the delays. It is good but not in health facilities,” he said.

When Nation sought a response from KNH regarding the delays, the Chief Executive Officer, Dr Evanson Kamuri, said that all patients who sought services at the hospital received treatment on the same day.

“However, it should be noted that patients come to the hospital with various ailments, some of which may require varying timelines to investigate. Whenever there are any delays, the hospital communicates to clients and liaises with other relevant institutions to have the matter resolved within the shortest time possible. Normal services resume thereafter with patients being given the best care possible,” Dr Kamuri said. 

He said the e-citizen platform “has improved our efficiency because of automation. We have integrated the platform well with the hospital systems making service delivery easier and faster for our clients.”

A weeks-long investigation by Nation journalists however indicated that delays on the government eCitizen portal have crippled several services in health facilities.

An estimated 1,000 lung cancer patients are unable to access medication for the past five months as the importer of key medicines has not been cleared to ship them into the country.

Kenyans have taken to various online platforms to express their dissatisfaction with the system, asking the government to revert to the old manual payments.

As part of the government's plan to integrate a one-stop shop for the payment of all services, the state last year prescribed the use of mobile phone paybill number 222222.

The directive has caused a delay in delivery of services. 

A company that made an eCitizen payment three months ago to import Pembroxim, which is a new-generation drug, has not been cleared to ship in the medicine.

“We have had complaints from several importers waiting to be cleared to bring in commodities in the country. We can’t do until the payment is reflected on our side and a clearance certificate generated for them to bring the drugs,” said a source at the Pharmacy and Poisons Board (PPB). 

The problem has persisted for months, he said.

“You know before the online platform system, it was easier. Whenever there was a shortage, payment was made to our accounts, clearance was done and the commodities were supplied. However, now we must wait for the money to reflect because we are not in charge of the system,” he said.

He said several drugs are in shortage in the country, but the scarcity is not being felt because there are generic forms of the drugs that can be used in place of the original.

“This was a nice way of sealing the loopholes of corruption in the public sector, however some things were not considered before implementation of the platform. It is not just here, things are not moving in government offices,” he said.

He indicated that the reported shortage of inhalers in the country was a result of the faults in the eCitizen payment system.

“We’re asking patients with lung cancer who were on this drug to have a conversation with their doctors to see whether they can be placed on another drug as we wait for the importation payment to reflect. I don’t know when this will happen,” he said.

Lung cancer accounts for 729 deaths annually, ranked 14th among all other cancers, according to Kenya National Cancer Control Strategy 2017-2022 data.

Among the various types of cancer, lung cancer stood out as the leading cause of cancer-related fatalities, accounting for approximately 1.8 million deaths in the same year.

For instance, according to the data from PPB, a vial of Pembroxim injection goes for Sh175,000, which is out of reach for the majority of patients. A patient needs at least four vials for it to be considered a dosage.

With high mortality rates and limited access to quality care, lung cancer continues to be a significant health concern locally and globally. According to the World Health Organisation, cancer is one of the leading causes of death worldwide, claiming nearly 10 million lives in 2020 alone.

Mr Mapelu Elo, the Kenya Network of Cancer Organisation chairman, indicated that they have had recorded several complaints from patients about the shortage of cancer drugs, with hospitals indicating that they cannot procure on time because of the delays in remitting monies from the National Treasury.

“Last week, we asked hospitals why they were not stocking drugs. They told us that there is a huge delay in getting money hence affecting the procurement process. The shortage has not only affected availability of lung cancer drugs but all cancers, we have patients suffering from different cancers including breast, and cervical who have gone for weeks without drugs,” said Mr Elo.

The National referral hospitals including Kenyatta and Moi Teaching and Referral Hospital are feeling the pressure of having to go without basic supplies since they do not have petty cash to pay providers.

“The hospital is running without drugs. When we want to buy anything we request the Treasury to release money and that takes time. Many patients are going without drugs and even our suppliers of food will soon stop supplying us. A number of them have not been paid for their previous supplies.

A spot check at the Moi Teaching and Referral Hospital (MTRH) showed that some patients seeking outpatient services settled their medical bills using the eCitizen platform.

When the Nation visited the facility on Thursday evening, there was a queue of patients waiting to be attended by a medical doctor.

“My wife has had stomach pains, we visited other facilities but the pain persisted. We did lab tests here for which we paid Sh3,000 via eCitizen. We were informed that NHIF services for outpatients were not working,” said James, requesting that we do not reveal his full names for fear of victimisation.

Some patients using the National Health Insurance Fund card are unable to access health services, claiming their payments were taking time to reflect on the hospitals’ records.

“When I went to the hospital, I was told that I had not paid Sh500 (the monthly premium) for last month, yet on December 2, I made payment. I was told that it could be the online payment system, said Ms Joyce Aturo.

The e-citizen Director General, Ambassador Isaac Ochieng, said he was not aware of the challenges reported by health facilities.

“If there is a problem why are they reporting to you,” he paused.

Additional reporting Stanley Kimuge, Angeline Anyango, Winnie Atieno