‘Pay cash or go without care’: Kenya’s growing healthcare access crisis
SHA's outpatient package is painfully inadequate. While inpatient care is covered, the more frequent outpatient treatments, crucial for long-term recovery, remain mostly out of reach.
Kenyans are facing a growing healthcare crisis that highlights a stark divide between the “haves” and the “have-nots”.
The most vulnerable citizens, who rely on the government’s Social Health Authority (SHA), are increasingly denied care as hundreds of private hospitals suspend services under the SHA scheme.
More To Read
- SHA resumes hiring after court declares previous process unconstitutional
- Court orders equal pay for UHC nurses amid absorption plan
- Row erupts over management of civil servants’ injury, insurance claims
- Crisis: Audit uncovers deep funding, staffing woes in public hospitals
- Religious leaders demand release of SHA funds to hospitals, warn patients’ health is at risk
- Ruto urges nations to take charge of health systems as donor funding declines
While private hospitals are often seen as serving wealthier patients, many Kenyans turn to nearby private clinics due to shortages, long queues, and distance challenges in public facilities. For low-income families, private care can be a necessity rather than a choice.
On September 22, the Rural and Urban Private Hospitals Association of Kenya (RUPHA) announced the suspension of SHA services at over 700 private and faith-based hospitals nationwide. This suspension puts thousands of lives at risk, leading to missed diagnoses, delayed treatments, and more pressure on overstretched public health facilities. Families are caught between a failing system and rising out-of-pocket costs.
Contrary to claims that the public rejects SHA, many Kenyans still hope the system can work but bear the brunt of its failures in silence.
Social Health Authority bottlenecks
Samuel Gitau, an Eastleigh Section 3 resident, who depends on a local hospital for his family's treatment, SHA might as well not exist. “My son was unwell recently, and I had to pay Sh1,100 for his treatment. Sometimes, you just don’t have the money. Insurance could make a big difference, but right now, it doesn’t. It’s cash, not insurance, that determines who gets care.”
Samuel Gitau. (Photo: Justine Ondieki)
James Nyau, a road accident survivor, depends on weekly physiotherapy at public hospitals. Despite being a fully paid SHA member, he pays out of pocket for most care. “Every week I pay Sh1,100 for a single physiotherapy session, plus other costs that SHA doesn’t cover. I’ve skipped sessions because of the cost,” Nyau said.
For Nyau, SHA's outpatient package is painfully inadequate. While inpatient care is covered, the more frequent outpatient treatments, crucial for long-term recovery, remain mostly out of reach.
"People think disability is just about needing a wheelchair. But for me, it's the pain, the travel, and the constant financial burden of trying to get better," he said.
Even before RUPHA’s announcement, several Nairobi private hospitals had stopped accepting SHA due to delayed or rejected claims and ongoing financial disputes.
In a press briefing, RUPHA Chairperson Dr Brian Lishenga said the suspension followed a two-week ultimatum issued on September 5 after SHA failed to address providers’ critical concerns. “Hospitals are now in financial paralysis, and our patients are at risk,” he warned.
Among the issues raised was a breach of contract after Health Cabinet Secretary Aden Duale ordered the blanket rejection of claims worth Sh10.6 billion on August 27, without following the SHA Provider Contract’s protocol for notification and clarification. Hospitals say they were denied timely feedback, leaving millions in unpaid bills.
RUPHA also accused SHA of abandoning the agreed “first-in, first-out” digital claims system in favour of opaque, human-led prioritisation, causing selective and unfair settlement delays.
A longstanding problem is SHA’s failure to clear historical debts, some dating back to 2017. Despite a presidential directive in March 2025 to settle verified claims under Sh10 million immediately, these remain unpaid.
Dr Lishenga emphasised that all liabilities, whether from NHIF or SHA eras, are now SHA’s legal responsibility.
A man purchasing medication at a pharmacy in Nairobi. (Photo: Justine Ondieki)
To restore confidence, RUPHA is demanding immediate payment of outstanding claims below Sh10 million, fast-tracked verification for larger claims, reversal of mass rejections, and the establishment of an independent dispute resolution tribunal, as provided for in law.
The association also calls for urgent reform of SHA’s financing model, which over-relies on salaried workers and neglects informal sector contributors, shrinking the funding base. They demand suspension of teacher and police health scheme migrations to SHA until the former insurer MINET clears pending hospital debts contributing to SHA’s Sh33 billion backlog.
Pay cash or go without care
SHA was designed to ensure no Kenyan is denied healthcare for lack of funds. But with implementation faltering and trust eroding, those it was meant to protect are suffering most. For now, many face a harsh reality: pay cash or go without care.
A recent study published in the International Journal for Equity in Health, 'Assessing the impoverishing effects, and factors associated with the incidence of catastrophic health care payments in Kenya', examined how out-of-pocket (OOP) healthcare costs are pushing households into poverty, and who is most affected.
The study found 4.52 per cent of Kenyan households spend over 40 per cent of their non-food budget on direct medical costs, a figure rising to 6.58 per cent when including transport expenses. Transport costs, often overlooked, significantly increase the financial burden of seeking care.
Each year, around 453,470 Kenyans fall into poverty due to direct health payments. Including transport costs raises this number to approximately 619,541. Before health costs, 66.6 per cent of Kenyans live below the national poverty line; this rises by 1.17 and 1.60 percentage points when accounting for medical and transport expenses, respectively.
The study revealed stark inequalities: poorer households face much higher risks of catastrophic health spending than wealthier ones. Nearly 10 per cent of households in the poorest quintile face catastrophic costs (rising to 15.68 per cent with transport), compared to just 1.29 per cent and 2.4 per cent in the richest quintile.
Risk factors for these costs include having an older or unemployed head of household, chronic illness or elderly members, large family size, living in marginalised counties, and rural residence. Rural households spend a larger share of income on healthcare and transport.
Top Stories Today
