The new Social Health Authority (SHA) rollout has left a teacher from Baringo Central, diagnosed with acute myeloid leukaemia, stranded in India for the past three months as she awaits health coverage.
Her urgent need for a bone marrow transplant, estimated at Ksh5 million, has been further strained by SHA’s ongoing onboarding of foreign hospitals and its Ksh500,000 payout cap, forcing her to depend on personal resources as approval processes continue.
According to the husband, they believed that transitioning from a teacher’s medical cover provided by a local firm would end their nightmare. Still, instead, all the money they were offered, they exhausted all of it.
Her family reports that they have already spent an additional Ksh5 million on chemotherapy, travel, and preparatory medical procedures.
Attempts to contact SHA officials were unsuccessful, with the agency maintaining that the accreditation process for foreign hospitals is still underway.
According to SHA CEO Dr Mercy Mwangangi, currently the system is paralysed due to the onboarding process, but it is being fast-tracked by he authority.
''Submissions from the hospitals and extending contracts, this process should be concluded by the end of February,'' she stated.
Currently, hospitals in India and Turkey are demanding upfront payments from Kenyan patients due to prior unpaid claims, leaving the patients without immediate access to care.
Under the SHA overseas insurance cover, the procedures covered included transplants such as liver, bone marrow, pediatric kidney, and laryngeal (voice box) transplants.
Major surgeries, including complex congenital heart operations, open-heart surgeries requiring life support, and specialised nerve treatments, advanced cancer treatments like bone marrow transplants for blood cancers, specialised radiation therapy, and immune cell therapies.
The family friends are currently urging the government to fast-track the process and increase the amount from the capped Ksh 500,000.
SHA is currently grappling with a Sh116 billion funding deficit, low compliance rates of around 18 per cent, and significant operational challenges that threaten service delivery.
Payment delays to both public and private providers, combined with a chaotic rollout, have resulted in high claim rejections and growing public distrust. Key challenges include financial sustainability concerns due to low contributions, particularly from the informal sector, which risks long-term viability.
Providers have also raised concerns that SHA tariffs are insufficient to cover the costs of medicine, consumables, and specialist services, leading to increased co-payments or withdrawal from the program.
Governance and trust issues persist, highlighted by the Auditor-General’s report on a disorderly rollout, lack of transparency, and the non-operational Dispute Resolution Tribunal.