The Commission on Administrative Justice has confirmed that the switch from the National Health Insurance Fund (NHIF) to the Social Health Insurance Fund (SHIF) is causing significant challenges in Kenya’s healthcare system, particularly for patients seeking medical services.
This finding comes after a visit by a team from the Ombudsman, led by Vice Chairperson and Commissioner for Access to Information, Dorothy Jemator, alongside Commissioner for Complaints and Investigations, Charles Njagua, who conducted spot checks at three hospitals in Nakuru County.
The team aimed to evaluate healthcare service delivery under SHIF and identify the challenges faced by hospitals and citizens.
“Many citizens raised concerns about hospital classification, which affects access to services noting that level 4 and 5 hospitals were not offering out patient services under SHIF, delayed reimbursements, and low awareness of SHIF processes. Hospitals also highlighted pending debts from the NHIF era, ongoing system failures, and the lack of a structured complaints resolution system,” stated the commission.
During the assessment, the team visited Nakuru County Referral and Teaching Hospital, Our Lady of Mercy Mission Hospital, and Valley Private Hospital, engaging with patients and hospital management to gather insights on their experiences with SHIF.
Dr. James Waweru, CEO of Nakuru County Referral and Teaching Hospital, stressed the need for the government to strengthen Level 2 and Level 3 facilities to improve access to quality healthcare, despite the positive intentions behind universal healthcare.
He pointed out that many young people in the county do not possess national ID cards, which hinders their ability to register under SHIF—an issue that particularly affects young mothers.
The Ombudsman’s visit was prompted by numerous public complaints about access to healthcare services under SHIF, especially regarding delays in reimbursements to hospitals and difficulties in accessing services. Moving forward, the Commission will work with relevant stakeholders to address these issues and ensure that the fund effectively serves its intended purpose.
