Chronic and critical patients forced to pay as govt funding falls short » Capital News
NAIROBI, Kenya, Feb 10 – Patients seeking chronic and critical illness services in Kenya’s public hospitals are now being forced to pay out of pocket due to the ongoing government financial crisis.
The funding shortfall has disrupted the financing of healthcare services across level 2 to level 6 facilities.
Medical Services Principal Secretary Harry Kimutai informed the National Assembly Health Committee that the Social Health Insurance Fund (SHIF) is only partially operational and currently covers emergency services for the first 24 hours after admission.
“At present, the fund provides coverage for urgent care, resuscitation, and stabilization for specific emergency services as outlined in the Gazetted benefit package. These services are free for the initial 24 hours, as the fund is Exchequer-funded. However, due to financial constraints in the current fiscal year, the chronic and clinical illness components of the fund have not been activated,” Kimutai told MPs.
Despite the Ministry of Health transitioning from the defunct National Health Insurance Fund (NHIF) to SHIF in October 2023, the emergency, chronic, and critical illness package was only partially operationalized in December, covering emergency services exclusively in level five and level six hospitals.
The financial crisis has left many patients unable to access the health package, resulting in numerous individuals being turned away from hospitals due to confusion over SHIF’s implementation and budgetary constraints.
“The implementation did not take effect immediately after the rollout on October 1. The system for these specific services was activated in December, starting with level five and six hospitals. As a result, claims only began coming in at the end of December,” explained Tracy John, the acting director for benefits and claims management.
Anthony Lenaiyara, CEO of the Digital Health Agency, confirmed that up to January, 21.6 million claims had been submitted under the fund, which was allocated Sh2 billion in the current financial year’s budget.
“This includes cases such as cardiac and pulmonary arrest, major trauma,” he noted, underscoring the strain on the healthcare system due to the funding gap.