Paying twice: SHA members forced to buy medicine out-of-pocket
The Social Health Authority headquarters in Nairobi on March 18. The authority is demanding upfront payment of full annual premiums.
Kidney patients at public hospitals across the country are enduring a painful paradox: despite paying thousands of shillings monthly to the Social Health Authority (SHA) and government assurances that medicines are fully covered, they are still forced to dig into their pockets for essential drugs.
The reality on the ground starkly contradicts recent promises by President William Ruto and Health Cabinet Secretary Aden Duale that medications are readily available under the Social Health Insurance Fund (SHIF) scheme.
Just two months ago, President Ruto assured Kenyans that essential medicines would be available in hospitals at county level, citing the revamped Kenya Medical Supplies Agency (Kemsa) as the solution.
"They now have no absolute excuse not to supply every commodity required by the counties," the President declared. "Counties must agree that as we settle their SHA claims, they also commit to paying for the medicines supplied."
On Monday, Health CS Duale reinforced this message, telling journalists that any Kenyan who has paid SHA contributions can access drugs at any hospital. He urged those asked to pay out-of-pocket to report such incidents through the ministry's hotline.
"We want Kenyans to report fraud. We want Kenyans to report when their benefits are denied or when they are asked to co-pay," Duale said.
However, for families like that of Sarah Kimani, whose father suffers from chronic kidney disease, these assurances ring hollow. Despite being fully paid up under SHA, the family continues to purchase medications out-of-pocket every month.
"Most of the time when we ask, they say they don't have the drugs," Kimani tells Nation. "Every month, we spend about Sh9,000 on drugs."
The family's monthly ordeal at Kenyatta University Teaching, Referral and Research Hospital has become routine: wake up at 6am, book a number, and see the nephrologist at 2pm – only to be handed a prescription tagged "to buy."
"All the time that we have been there, we have never found our prescribed drugs," she explains, questioning whether medications exist in the hospital or are reserved only for inpatients.
The financial burden is crushing. As an employee, Sarah is deducted Sh25,000 monthly by SHA – money she believes should cover those in the informal sector or unemployed. Her retired, widowed father contributes an additional Sh300 monthly as determined by SHA's means-testing tool.
"I feel cheated," she says. "My argument is, if we are paying for SHA, then patients should get holistic care when they reach the hospital."
For Sarah, the transition from the National Hospital Insurance Fund (NHIF) to SHA has brought no relief. "I see no difference from when I was paying Sh900 to now when I pay Sh25,000. We are still buying drugs out-of-pocket, still queuing to see specialists, still fighting for hospital beds."
She recounts a particularly harrowing experience: "There's a time we queued from midnight to 4am and only got a bed because someone died."
The family's domestic worker at Mbagathi Hospital faced similar challenges, having to purchase medications externally despite paying Sh1,000 monthly to SHA.
"The stock-outs of medicines shock me," Sarah adds. "We are always queuing at River Road to buy medicine because it's cheaper there. You'll always find queues of people buying drugs out-of-pocket."
John Gikonyo, President of the Renal Patients Society of Kenya, confirms that drug shortages nationwide are not new. He explains that one of the biggest barriers to kidney transplants has traditionally been post-transplant management costs.
"We have started receiving support for post-kidney transplant under SHA. The package offers Sh700,000 for transplant and another Sh200,000 for post-transplant management," Gikonyo explains.
However, this benefit is only available at two public transplant hospitals: Moi Teaching and Referral Hospital and Kenyatta National Hospital.
"This becomes complicated for people who don't live near those facilities," he notes. "It would be easier if other hospitals could host these drugs for ease of access."
For post-transplant patients, missing medications can have devastating consequences. "It is very, very frightening if you are not able to get these drugs because of the aftermath," Gikonyo warns. "A patient may experience rejection and have to return to dialysis. That would be a great waste of all the good work done to provide a kidney transplant."
Despite ongoing challenges, he maintains cautious optimism about SHA.
"There are hiccups here and there under SHA, but we cannot go back to NHIF. We have to work with what we have and support the Social Health Authority as they try to get everyone on board."
Dr Tracey John, Acting Director of Benefits and Claims Management at SHA, acknowledges the teething problems raised by patients and says the authority is working to address them.
"We have received such comments in the past, and those are areas already being addressed to ensure facilities operate at optimal capacity based on their level," she told Nation.
She explains that kidney patients may sometimes miss out on drugs from their primary package when they have prescriptions for underlying conditions such as high blood pressure or diabetes.
"When a patient goes for dialysis, their care includes investigations, treatment, and the dialysis itself – it's a comprehensive package," Dr Tracey says. "Most dialysis patients have other underlying diseases requiring regular check-ups, and we have other packages whose benefits are mostly found in Level 6 facilities."
The government continues working to ensure holistic healthcare provision, particularly for post-transplant patients, while working to decentralize access to care.
"Kenyans should be aware of how services are distributed in line with the benefits so they can maximize what they are entitled to," Dr Tracey concludes.
All employed Kenyans contribute approximately 2.75 per cent of their gross monthly income to SHA, while others pay varying amounts determined by the scheme's means-testing tool.
