A recent survey conducted between October 24 and October 25, 2024, in public, private, and mission hospitals across Nairobi, Kiambu, Meru, and Bomet counties has exposed substantial barriers facing non-communicable disease (NCD) patients under the Social Health Insurance Fund (SHIF). Responses from these facilities highlight significant gaps in service delivery, which have hindered many patients from accessing essential healthcare services in a timely and effective manner. Systemic issues in SHIF, such as delays in care and administrative bottlenecks, have left many NCD patients, including those with cancer, diabetes, and cardiovascular diseases, struggling to receive the support they need.
The Caucus of Patient-Led Organizations of NCDs, which spearheaded the survey, has called for urgent action from the Ministry of Health and SHIF management to address these challenges. Their recommendations focus on improving the SHA rollout to ensure it can effectively meet the healthcare needs of patients with chronic and complex conditions.
Key Recommendations
- Restore SHIF Coverage for Overseas Treatment:
SHIF should resume coverage for patients requiring specialized treatment that is not available locally. This move would provide relief to patients with complex conditions who need advanced care options abroad. - Clarify and Publicize SHIF Benefit Structures:
Transparent communication regarding SHIF benefits is essential for restoring patient trust. The Caucus recommends that SHIF clearly outline its benefit structures and ensure they are accessible to the public. - Address Administrative Delays:
The Caucus emphasizes the need to streamline registration, preauthorization, and payment processes. Promptly addressing these system inefficiencies could significantly reduce waiting times and improve patients’ overall experience in accessing care. - Settle NHIF Debts to Empower Service Providers:
Many healthcare providers hesitate to accept SHIF patients due to outstanding NHIF debts. Resolving these debts would alleviate financial strain on patients and encourage providers to continue offering SHIF-supported services. - Launch Public Awareness Campaigns:
The Caucus advises that SHIF increase public awareness regarding its benefits, registration process, and financing options. This would help patients make informed decisions about their healthcare. - Engage Patient Organizations and Civil Society:
Incorporating patient perspectives through engagement with civil society and patient organizations can help ensure that SHIF’s services are responsive to patient needs.
Patient Advocacy Call for Action
Evans M. Majau, Chair of the Caucus of Patient-Led Organizations of NCDs, stated, “The survey findings reveal critical gaps in SHA’s ability to serve Kenyan patients effectively. To achieve the goal of universal health coverage, SHA must prioritize transparency, access to specialized care, and patient inclusion.”
The Caucus remains committed to advocating for an inclusive healthcare system that guarantees quality, timely care for all Kenyans. Through collaboration and decisive action, Kenya can move closer to achieving equitable healthcare for all.
