(When promises of access became walls of exclusion; Prescription for more suffering)
By John Wesley
They promised SHA would heal NHIF’s wounds, restore faith in public health insurance, and shield ordinary Kenyans from paying for illness with their savings. Instead, what we have is bills that vanish into ghost clinics, contracts controlled by private firms, and facilities punished for speaking truth. Kenya’s health system is seeing insurance become illusion…and it is the sick, the poor, and the hopeful who suffer most.
When Social Health Authority (SHA) began operations in October 2024, many breathed sighs of relief. NHIF had become a byword for corruption and broken promises. A new law, new structure, clean slate. But barely a year in, the skeletons burst from the closet.
KSh. 10.6 billion in claims have already been rejected for suspected fraud, noncompliance and inflated or false billing. Shadow hospitals—non-existent or non-functional…were being paid, while genuine clinics struggle to clear payments for real patients. A digital health contract worth KSh. 104.8 billion; intended to bring transparency…was instead awarded without competitive bidding, and worse: its systems remain owned by private contractors instead of government control.
And then there’s the human cost.
Maria in Kisumu waits for medication she’s entitled to under SHA, but the facility says her claim “has not been authorized.” She pays out of pocket. David from Embu has to turn away his sick child at a hospital because the ambulance service tied to SHA claims is delayed. A woman in a remote county who was promised safe maternity under SHA loses blood supplies because the facility where she is registered is under suspension. These are not hypothetical…they are lived realities of many.
Hospitals are being suspended; over 45 flagged for fraudulent claims so far. The government, through SHA and the Digital Health Authority (DHA), has closed nearly 1,000 non-compliant facilities and downgraded many others. But much of the damage is already done…bills unpaid, lives disrupted, trust shattered.
Then there is KNH and JOOTRH. JOOTRH was elevated to Level 6 status, giving it expectation of higher standards, more resources, greater service. Its acting CEO, Dr. Lesiyampe, has been moved to lead the apex referral KNH, supposed to steer reforms. Yet these leadership changes feel like cosmetic shifts when the fundamental structure remains flawed. Hospitals still run without enough staff. Tender processes for essential equipment are riddled with delays. Patients still pay for what should be free.
SHA was to be the shield in Kenya’s healthcare, replacing NHIF’s long broken promise. But a shield that leaks does more harm than good. It has reached a point where ordinary Kenyans, disillusioned by the chaos of SHA, are openly demanding the return of NHIF. For all its rot and scandals, NHIF at least felt familiar, predictable, and easier to navigate. Today, with ghost hospitals siphoning billions, real facilities going unpaid, and patients stranded, many whisper what was once unthinkable. When insurance becomes a token, when trust is traded for headlines, democracy’s promise in healthcare falls like a house made of cards.
This is the moment Kenya needs more than reforms. it needs reckoning. It begins with clear ownership of digital systems. It begins with payment transparency. It begins with suspended facilities being rehabilitated, not just silenced. It begins with inclusion of patients’ voices so that someone like Maria is heard, not ignored. It begins with leaders who serve healthcare, not healthcare serving their image.
We have laws that promise health as a right. We have institutions meant to deliver. But until those institutions stop stealing hope, until contracts are guided by fairness, until hospitals are places of healing not billing, we’re left with illusion.
Insurance must become insurance again. Not illusion. Not privilege. The health of Kenya’s people depends on it.
