Billions at risk as MPs uncover flaws in troubled SHA system

The National Assembly’s Departmental Committee on Health has launched a countrywide fact-finding mission into the troubled Social Health Authority (SHA) system.

This is amid mounting complaints over payment of ghost hospitals, delayed claims, rejected payments, and fraud allegations that are threatening to derail the government’s universal health coverage plan.

It is suspected that Sh24 billion could have been lost in the scheme through fraudulent claims.

The committee, chaired by Seme MP James Nyikal, visited Homa Bay after earlier whistle-stop tours of several health facilities, among them St. Elizabeth Swindon Hospital, Matata Nursing Hospital, the proposed Nyandiwa Health Centre, Rachuonyo Level 4 Hospital in Kasipul Constituency, and Nyandiwa Level 4 Hospital in Suba South.

Other facilities inspected include Nyahururu County Referral Hospital, Nyeri County Referral Hospital, Nasili Maternity Nursing Home, Sipili Maternity Nursing Home, and Nasili Medical Facility, both private institutions.

Their visits painted a picture of a health system with potential but weighed down by serious teething problems. 

Among the challenges identified was that while members who have paid their premiums are able to access services, those who have only registered without making payments are locked out.

Outpatient funds have been allocated, but the system is still performing poorly, while emergency funds released by the government are not being processed effectively.

Seme MP noted that the transition from the defunct National Hospital Insurance Fund (NHIF) to SHA had created confusion, leaving both hospitals and patients struggling to access services.

“We have found that the systems for registration and claims exist, but they have not been well understood. Some claims are delayed, others are returned or rejected.

"The challenge is worsened by the fact that SHA does not yet have local offices, making follow-up nearly impossible,” Nyikal explained after a visit to Nyandiwa Health Centre.

The MP dismissed claims that some health facilities had allegedly received payments from SHA despite not being operational, a matter that has fuelled suspicions of misdirected funds.

“We cannot yet confirm whether some of the fraud claims are true, as our probe is still ongoing. For instance, there was an allegation that Nyandiwa Health Centre had been paid.

"Yet, on inspection, we found it was only a proposed facility by the Homa Bay County Government. It is not operational and does not even have an account. However, we discovered another facility with a similar name in Suba South, which may have been the actual recipient of the funds.”

The MP assured Kenyans that the committee’s priority is to ensure SHA operates smoothly so that all Kenyans can benefit.

“The system has potential, it is not yet performing as expected, but it is functioning in part, and we want it to work better,” said Nyikal.

Further, he backed Health Cabinet Secretary Aden Duale’s move to submit the names of implicated facilities to the Directorate of Criminal Investigations (DCI) for probe.

“If corruption is found, individuals must face the law. What we caution, however, is that innocent hospitals should not be punished because of systemic changes, as this only ends up hurting patients,” he said.

Other committee members echoed Nyikal’s sentiments, underscoring the need for both accountability and urgent corrective measures.

Kisumu Central MP Joshua Oron urged SHA to devolve its services to the county level, saying this would ensure faster resolution of challenges facing hospitals.

Speaking after inspecting health facilities in Homa Bay, Oron acknowledged that the new system has encountered “teething problems” but emphasized that it remains a strong initiative.

“What we have heard repeatedly across all facilities is that SHA is a good initiative and is working, but the challenges must be addressed,” said Oron.

The MP stressed that the focus should now be on sealing loopholes and strengthening devolved structures to make the SHA system more responsive.

Lurambi MP Titus Khamala called for a united front in tackling corruption in the health sector, warning that fraudulent claims are crippling facilities and undermining service delivery.

“The issue of corruption, fraudulent claims, and exaggerated claims has brought us to where we are with some facilities,” Khamala said.

Khamala urged Kenyans to adopt a holistic approach to rooting out corruption, insisting that both institutions and individuals must play their part.

On her part, Nandi MP Cynthia Muge reminded Kenyans of Parliament’s oversight role.

“We are here as representatives, legislators, and overseers. Our goal is to ensure that SHA delivers universal health coverage as envisioned. We want Kenyans to have confidence that we are listening to them and will make sure the system is improved,” said Muge.

Ndhiwa MP Martin Owino ruled out any possibility of reverting to the NHIF, insisting that SHA must be actualised to realise Universal Health Coverage.

“NHIF is done. It’s gone. That house was brought down. We want Kenyans to know there’s no reverting to NHIF. Now we have SHA, and our resolution as a committee is that it must work for the people,” said Owino.

But he warned that while SHA was introduced with great enthusiasm, early challenges could discourage citizens from seeking care.

“When SHA was introduced, people came in numbers seeking services. But if these teething problems are not managed well, people will shrink back, resorting to alternatives like self-medication. That is not what we want. We must capture and sustain that eagerness to seek care,” he cautioned.

The MP also faulted the centralisation of services, which forces facility proprietors to seek solutions from headquarters instead of county offices.

He praised Homa Bay County health officials for their proactive role in addressing health challenges at the local level, noting that decentralisation is key to success.

Owino further made a passionate appeal for continued investment in maternal and child health.

Homa Bay has not reported maternal death for the past six months, apart from a single case reported last month.

In Kenya, at least 21 women die at birth, everyday due to maternal-related complications like excessive bleeding.