Clients walk towards the newly rebranded Social Health Authority (SHA) building on October 1, 2024, as the government officially rolled out the healthcare service provider.
Hospitals have reverted to the old National Hospital Insurance Fund (NHIF) system while others struggle with manual processes to process patients.
This comes as the crisis triggered by the introduction of the Social Health Authority (SHA) system continues in hospitals across the country.
At the centre of the crisis is the failure of the Integrated Healthcare Information Technology System (IHTS), which was procured by the government from a Safaricom-led consortium at a cost of Sh104.8 billion.
This technological failure has forced hospitals to revert to the old NHIF system and manual processes, causing inordinate delays and worsening patient suffering.
Speaking to the Nation on Wednesday, ICT experts at the Digital Health Agency (DHA), which is tasked with implementing the new SHA system, confessed that they were still trying to learn the system themselves and needed some time to fully understand it.
“Remember this is a new system that the government procured. It’s not like we designed it from scratch. We are still trying to study the components of the system that was procured by the Health ministry so that we understand completely as we even embark on training hospital staffers across the country on how to use it, so hitches are bound to happen,” said a senior official at DHA, who is a member of the team implementing the rollout but is not authorised to speak to the media.
The official also stressed that the technological challenges the SHA system is struggling with have made it almost impossible for health facilities to process and sort out claims, and that the biometric component of the system is also still a huge problem.
The Nation found that most public and private health facilities, including those in Kakamega, Nairobi, Eldoret, Mombasa, Kiambu, Machakos, Murang'a and Mandera are struggling with the systems and patients cannot understand them.
"The NHIF system is much easier to use because the claims system that SHA has is a bit complex and the system keeps failing," a hospital administrator in Kiambu told the Nation.
Another CEO of a major referral facility said the new system has challenges that have compelled them to sort out patients using the NHIF.
When the Nation asked Medical Services Principal Secretary Harry Kimtai where Kenya procured the Sh104.8 billion system from, he referred us to Safaricom.
“I don’t know. Go and ask Safaricom,” PS Kimtai responded in a telephone interview.
On September 25, 2024, the Departmental Committee on Health led by Endebess MP Dr Robert Pukose summoned Ministry of Health officials after the new system failed massively during test runs in Marsabit and Tharaka Nithi counties.
Last week, acting SHA CEO Elijah Wachira apologised to Kenyans for the chaotic rollout of the Social Health Insurance Fund (SHIF), which threw the entire healthcare system into disarray and left thousands of patients across the country stranded and in pain.
Mr Wachira said that before the government embarked on the rollout, a lot of work was done to ensure the systems were ready.
“Not only to register Kenyans but also to recognise them when they go to hospitals, and submit the claims for payment. That is what I had been shown by a government agency called the Digital Health Agency (DHA), which is indeed coordinating this, “he said.
“We commenced the rollout of SHIF and called upon Kenyans to go out and register, a process I would say was successful up to 80 percent.
Why I am not giving it 100 percent is because it was evident that when many people tried to get into the system, the system got clogged and some of the registration exercises were not successful," the CEO added.
According to Mr Wachira, when they realised what was happening, they immediately spoke to the technical people at DHA.
“They expanded the bandwidth so that it can accept more information, process and release it, and as a result, registration stabilised, which is why we were able to progress."
The acting CEO further pointed out one of their biggest headaches.
“When someone ‘got queued’ to register digitally, many of them tried again and again and again and so if there was 10 of us trying to register at the same time and were trying many times with some doing 70 to 100 attempts, that caused more confusion in the system which we addressed by sending text messages to Kenyans who were doing so to tell them we have received, we are processing, relax, we shall get back to you.”
Secondly, Mr Wachira admitted that the claims processing system had not been able to work as envisioned, meaning that biometrics was still a major challenge.
Mr Dagane agrees with SHA's acting CEO.
“We are helping patients with registration and migration from NHIF to SHA and have noticed many of them are still having issues with logging in and signing up and will attempt over 10 log-ins at the same time.
Now, if thousands of patients in over 1,000 health facilities around the country are doing the same again and again, it means the system will experience challenges. That is what is happening," he said in a telephone interview.
On Sunday, SHA chairperson Dr Abdi Mohamed said 1,442 health facilities had signed contracts with SHA.
“We had earlier reported a total of 1,577 health facilities contracted, however, this was an error due to duplication of names of some facilities. The list of all contracted health facilities is available on our official website,” he clarified.
Meanwhile, civil servants have warned that the transition to the new Social Health Insurance Fund (SHIF) will be a headache for patients.
The Union of Kenya Civil Servants has called on the government to include comprehensive medical coverage in the SHIF.
UKCS Deputy National Organising Secretary Wilson Asingo expressed concern that the continued delay in the implementation of the expanded scheme is burdening thousands of civil servants and their dependents who are currently admitted or undergoing treatment at various health facilities.
The comprehensive cover administered by the defunct National Health Insurance Fund (NHIF) covered all services, including radiotherapy, chemotherapy and dialysis.
With the collapse of the NHIF on September 30, 2024 and the coming into effect of the SHIF on October 1, patients have been forced to pay out-of-pocket as they await the new enhanced scheme.
“Our members seeking specialised services have experienced significant difficulties over the last week and this matter should be handled urgently,” Mr Asingo said on Sunday.
The benefits of the package rolled out on January 1, 2012, were improved to cover outpatient, inpatient, and specialised services, dental, optical, annual medical check-ups for members and spouses, road ambulance, emergency air rescue services and overseas treatment.
“The comprehensive medical scheme has formed part of the benefits for civil servants and has been entrenched in all the successive Collective Bargaining Agreements (CBAs),” Mr Asingo said.
He noted that the enhanced package, which covers civil servants and staff performing functions devolved to county governments, was improved after they gave up their medical allowances.
Ahead of the transition to SHIF, the Ministry of Public Service, Performance and Delivery Management set July 4, 2024 as the deadline for interested insurance companies to submit their bids to provide comprehensive cover under the new scheme.
Mr Asingo, however, warned that the delay in the procurement of the scheme was exposing civil servants to unwarranted suffering, economic pressure, anxiety and mental anguish, while creating unnecessary speculation about the uncertainty of the scheme.
“The packages offered, having been reviewed and improved with time, were superior and we expect nothing less than what NHIF was offering,” the UKCS official said.
Under the expired NHIF comprehensive cover, hospitals offered all-inclusive services to members of the enhanced scheme free of charge (walk in and walk out).
Enhanced scheme members with higher allocations could also access non-comprehensive hospitals on a fixed fee-for-service (FFS) basis.
Additional reporting by Victor Raballa
