SHA expands chronic care cover, but access remains a challenge

Kennedy Anjejo walks into Lake Victoria Sub-County Hospital in Kisumu twice a week for kidney dialysis.

Alongside dialysis, he receives blood boosters to help manage anaemia, a common complication among patients with kidney disease.

The services are offered under the Social Health Insurance Fund (SHIF), easing a cost he previously met out of pocket.

Under the defunct National Hospital Insurance Fund (NHIF), Anjejo had to spend between Sh1,000 and Sh1,500 on the blood boosters.

“I lose some blood after dialysis. To boost it, I take blood boosters, which are now provided under SHA,” he says.

The change has offered some relief to Anjejo, who depends on regular treatment to manage his condition.

SHA pays Sh10,650 per dialysis session, up from Sh9,500 under NHIF.

Anjejo also says the new scheme has made it easier for patients to seek care at a facility of their choice, unlike under NHIF, when patients had to select their preferred hospitals.

But while coverage has improved, the full package of kidney care remains uneven.

For example, the frequency with which patients receive blood boosters varies between facilities.

In some Nairobi hospitals, patients receive them every week, while their counterparts elsewhere are limited to once a month.

“Patients out of Nairobi are forced to pay out of pocket to get boosters weekly,” says Anjejo.

Blood boosters help maintain haemoglobin levels during dialysis. Without them, patients may experience fatigue, headaches and other complications associated with anaemia.

“The biggest problem is ensuring that patients get the services they are entitled to. If nobody follows up, patients may not receive the full package,” he adds.

Anjejo’s experience illustrates how SHA has expanded support for people living with chronic diseases, covering essential services such as dialysis and kidney transplantation.

The benefits extend beyond kidney care to cancer and sickle cell disease, offering relief to families who have often struggled to sustain treatment costs.

Kidney transplant surgery is covered up to Sh700,000, with Sh168,000 allocated for donor surgery, known as nephrectomy.

A further Sh200,000 is allocated per household annually for post-operative care and medicines.

The surgeries are subsidised at Kenyatta National Hospital and a number of private hospitals.

For families managing other chronic illnesses, particularly cancer, the financial burden can be overwhelming.

Treatment often involves repeated hospital visits, medicines, diagnostic tests and specialised procedures, costs that have forced some families to sell property in search of care.

Fridah Kabeyi, a breast cancer survivor, knows the financial burden that comes with the disease.

Diagnosed in 2016, the mother of three from Soi, Uasin Gishu County, underwent a mastectomy, followed by chemotherapy and radiotherapy.

She has been in remission for nine years and continues to undergo regular medical reviews to monitor her health.

But in May this year, her life took an unexpected turn when her 77-year-old mother, Rose Osango, was diagnosed with breast cancer.

Kabeyi was forced to confront the disease once again, this time as a caregiver.

Osango had complained of a lump in her left breast, but Kabeyi and her siblings delayed taking her for medical checks, fearing what the diagnosis might reveal.

Their fears were confirmed when tests at Moi Teaching and Referral Hospital (MTRH) showed that Osango had Stage 3 breast cancer.

She was started on chemotherapy and has since completed six of the eight scheduled sessions.

Each chemotherapy session costs between Sh10,000 and Sh14,000.

Fortunately, SHA has covered the sessions, easing the financial pressure on the family.

The scheme also paid for Osango’s first hormonal balancing injection, which cost Sh68,000.

However, her own experience exposes the difficulties patients still face in accessing the new benefits.

“So far, SHA has eased our mother’s treatment. We only spent Sh2,000 out of pocket for her haemogram test,” says Kabeyi.

Having undergone cancer treatment herself, Kabeyi understands the physical and emotional toll it takes.

Watching her mother go through a similar experience has brought back painful memories, but this time the family has SHA to help meet the cost of care.

Osango was registered for the SHIF in May and paid an annual premium of Sh5,720 through means testing.

For a family confronting cancer for the second time, the financial relief has been significant.

Kabeyi says the new scheme has been more helpful than NHIF, particularly because she has not had to make the additional payments she previously encountered.

Under NHIF, she recalls, the Fund covered part of her treatment costs, but she was often required to pay the difference, especially for medicines.

“NHIF would pay Sh25,000 for my chemotherapy, but I would be asked to pay an additional Sh5,000. With SHA, there has been no top-up,” she says.

NHIF also paid Sh100,000 for her surgery.

But Kabeyi notes that cancer treatment is not a one-off expense. Patients require repeated hospital visits, tests, medicines and follow-up care, costs that can become difficult to sustain over time.

Even as she praises SHA for covering her mother’s chemotherapy, Kabeyi raises concerns about gaps in follow-up care and investigations.

She questions the limits on certain investigations, including CT scans and echocardiograms, which she says are covered only once a year.

She also says approval of services under SHA takes longer than it did under NHIF, potentially delaying care.

“Delays in approval of services are a major challenge with SHA. This should be improved to enable patients to get care on time,” says Kabeyi.

“At the moment, SHA has given my family financial breathing room as we focus on the next stage of treatment,” she adds.

Under SHA, the annual cancer benefit has increased from Sh550,000 to Sh800,000, expanding the package available to patients undergoing treatment.

The oncology package includes consultations, chemotherapy, radiotherapy, diagnostic investigations and specialised treatment options, alongside supportive care.

Holistic oncology consultations are covered at up to Sh2,500 per visit, with a limit of four visits. Chemotherapy administration is allocated up to Sh5,500, according to the treatment plan, while radiotherapy is covered at Sh3,600 per session for up to 30 sessions.

Cancer CT scans are allocated Sh6,900, while brachytherapy is covered at Sh40,000 for three sessions.

The package also includes specialised diagnostic services such as MRI and PET scans, as well as other treatment options, including stereotactic body radiotherapy and stereotactic radiosurgery.

In an interview with The Standard, Health Cabinet Secretary Aden Duale said the benefits were intended to improve access to care and reduce out-of-pocket expenditure.

“To strengthen cancer care and shield families from catastrophic medical costs, the annual cancer benefits package has increased from Sh550,000 to Sh800,000,” said the CS.

According to SHA CEO, Dr Mercy Mwangangi, more than 48,000 cancer patients have accessed treatment since SHA replaced NHIF.

Additionally, about 16,800 patients have accessed dialysis, with the majority receiving at least two sessions every week.

Patients with sickle cell disease have also gained access to specialised services under SHA that were previously limited and inaccessible to many.

The package provides Sh20,000 for apheresis platelets and Sh70,000 for red blood cell exchange.

Each service is covered up to three times per policy period, according to a gazette notice issued by the Health CS.

Apheresis is a procedure in which a machine separates and collects specific blood components, such as platelets, while returning other components to the patient.

Red blood cell exchange involves removing abnormal red blood cells and replacing them with healthy donor cells.

Michelle Asesa Omullo, who lives with sickle cell disease, welcomes the inclusion of the services but says patients must be able to access what has been promised.

“We appreciate SHA caters for sickle cell services, unlike NHIF, which was not providing any care,” she says.

However, her own experience has exposed the difficulties patients still suffer, despite new benefits.

On August 4, Omullo travelled from Kisumu to Nairobi for a red blood cell exchange procedure but did not receive the service.

But she was turned away at a private facility after being told that her SHIF cover had been exhausted in January, despite having used it only once that year.

With no other option, she contacted her employer, who arranged for the procedure to be covered under a private medical insurer at a cost of Sh150,000.

“I was in so much pain when I was turned away. Does SHA really know what sickle cell patients go through?” poses Omullo.

Omullo was diagnosed with sickle cell disease at the age of three at Kenyatta National Hospital after presenting with jaundice.

The condition affects haemoglobin, the protein in red blood cells responsible for carrying oxygen around the body.

She has suffered two strokes, in August 2010 and February 2013, and relies on red blood cell exchange to help manage the effects of the disease.

The procedure involves removing abnormal red blood cells and replacing them with healthy donor cells.

In 2025, Omullo became the first patient to undergo an automated red blood cell exchange transfusion in a public hospital.

The procedure is among the specialised services introduced under SHA and was not covered under the defunct NHIF.

Under the expanded package, red blood cell exchange is allocated Sh70,000 per procedure, while apheresis platelets are allocated Sh20,000.

Each service can be accessed up to three times within a policy period.

The new benefits offer a form of financial protection that sickle cell patients did not have under NHIF.

But Omullo says her experience raises questions about whether patients can access the services in practice.

“Why does SHA tell patients that red blood cell exchange is covered three times a year when it is not? Yes, we are happy that SHA has included the procedure for sickle cell anaemia, but as it stands, we are not accessing care,” she says.

With her experience, Omullo wants the government to review the allocation for red blood cell exchange, proposing that it be increased from Sh70,000 to Sh120,000 and that patients be allowed four procedures a year instead of the current three.

She also cites frequent SHA system downtime and other access challenges, which she says continue to undermine care for people living with sickle cell disease, particularly those without private medical insurance.

To further strengthen access to specialised services, SHA has contracted nine international hospitals for referrals, with coverage capped at Sh500,000.

Overseas referrals are, however, limited to services not available in Kenya.

mkahenda@standardmedia.co.ke