Cancer patients decry financial and emotional distress under SHA

There is a growing concern over the status of cancer financing in the country after it has emerged that about 13.5 per cent of Kenyans are forced to abandon treatment completely because they are too poor to pay for medication.

According to a new survey by Kenya Network of Cancer Organization (Kenco), which also showed that 60 per cent of cancer patients had exhausted their Social Health Authority (SHA) cover before the end of the year. At the same time 35.8 per cent exhausted their benefits in less than three months while another 34.3 per cent deleted their cover within three to six months.

Kenco Executive Director Phoebe Ongadi told the National Assembly Committee on Health yesterday that among those whose cover ran out, 38.5 per cent were able to pay out of pocket, 27.9 per cent could only pay partially while 20.2 per cent could not pay for treatment at all and another 13.5 per cent were forced to abandon treatment completely.

She told the committee that at least 44,000 new cancer cases are diagnosed every year and another 29,0000 deaths reported annually, with the numbers expected to be higher.

Ongadi said the numbers are based on the Globocon 2022, which is the latest report, an indication that the numbers could be higher and a situation that calls for enhanced monitoring locally to save lives.

Similarly, she said that 70 per cent of cases are being diagnosed late, with breast, cervical and prostrate, esophageal being the most common cancers in the country.

“Locally, we need to strengthen the national registry to be able to collect data because I believe the Globocon data could be lower than what we have on the ground so we also need to push for the national cancer registry to be able to collect data and we can have the correct data for us to come up with ideas and strategies that help us deal with the cancer,” she said.

She observed that under SHA, although patients are expected to pay annually and with the high cost of treatment, their cover depletes, even as they called for an adjustment of the annual limit and reintroduce monthly premium payment options for vulnerable households, away from the loan model through Hustler Fund.

“Patients are expected to pay annually and there is a problem because of the high cost of treatment, they are not able to put together that annual treatment. We are not refusing to pay but we are saying annual payment is too much, the one-off payment is too much for many patients so can we have a flexible way,” she said.

They raised concern over what they described as growing emotional and financial distress caused by the new Social Health Authority (SHA) system, saying delays, opaque approvals, and inflexible payment terms are worsening their suffering and threatening their treatment continuity.

Kenco painted a grim picture of what they termed a broken system that has left thousands of cancer patients stranded, despite being fully paid-up members of the new health scheme.

For instance, Kenco cited a patient’s case where the direct cost of comprehensive treatment exceeded Sh3.8 million, a situation that demonstrates that the current SHA cancer cover of Sh550,000 is grossly insufficient to provide equitable access to care.

Currently, oncology patients are covered to the tune of Sh550,000 per household per year while under the previous scheme, the National Hospital Insurance Fund (NHIF), they were entitled to an annual cover of Sh600,000 per individual, with the added flexibility of utilizing their spouse’s cover oncer their own benefits were exhausted.

“These findings confirm that the current oncology cover is grossly inadequate for the financial realities of cancer treatment and that SHA has not protected households from catastrophic health expenditure. Reducing the oncology package is not just a technical policy change – it is a life and death decision for thousands of Kenyans. While SHA was envisioned to expand access, this reduction has effectively reversed gains made under NHIF,” Kenco said.

The organization urged the Ministry of Health and SHA to increase the oncology benefit to at least Sh1.2 million per individual per year and ensure the emergency, chronic and critical illness fund (ECCIF) are clearly accessible and not theoretical and that they are increased gradually.

They regretted bureaucratic delays, system failures and unresponsiveness, saying that cancer treatment is time sensitive yet delay even for a few days can mean disease progression, worsening prognosis or treatment failure.

At the same time, Kenco said that SHA’s current administrative systems have created bureaucratic bottlenecks that prevent timely access to care.

“Findings from Kenco’s 2025 survey show that 65.3 per cent of patients experienced delays in SHA approvals, with nearly one in five (19 per cent) facing delays exceeding one week. Over half, 55.9 per cent reported being denied treatment due to system indications of depleted or expired accounts even when premiums were valid,” Kenco told the committee.

While 69.5 per cent of respondents had contacted SHA customer care, nearly 48 per cent said they did not receive the support they needed and another 36 per cent only received partial assistance.

Some 60.2 per cent had been denied treatment at least once due to SHA system failures, with many reporting such incidents multiple times.

The organization has also stated that the cost of chemotherapy, radiotherapy, surgery, and follow-up medication has made cancer a medical and financial nightmare.

Kenco cited a case of a patient diagnosed with triple-positive breast cancer who end up paying paying in excess of Sh3.8 million from a public health center ends up.

According to Kenco, a standard chemotherapy session costs Sh21,000, amounting to Sh168,000 for the recommended eight sessions while blood works cost Sh4,500 totaling to Sh36,000 for the eight cycles.

Imaging and diagnostic monitoring raise further raise the cost, including a CT scan (Sh20,000) echo-cardiograms every three months (Sh3,000) and a PET scan at Sh53,400.

The patient will also undergo targeted therapy. Herceptin alone costs Sh33,800 per cycle for 18 cycles (or more for some patients) amounting to Sh608,400.

“Kadcyla, often prescribed for maintenance or resistance cases, costs Sh180,000 per cycle for 114 cycles – a staggering Sh2.52 million,” said Kenco chairperson Prisca Githuka.

The organization also stated the cost of hormonal therapy, including Zoladex (Sh19,615 every three months indefinitely) and Letrozole (Sh5,000 for a three-month dose over 10 years), all totaling to Sh100,000 in one year alone.

To undergo radiotherapy, the patient is expected to use an average of Sh3,600 per session for the recommended 30 sessions totaling to Sh120,000.

These added to Sh120,000 for surgery and another CT scans of the chest and pelvis costing Sh8,000 and Sh12,000 respectively would see such a patient spending Sh3.8 million in a year.

In another documented case, a caregiver told Kenco that her sister was battling stage 4 breast cancer that has metastasized to the liver, lungs and brain and has completed six sessions of chemo and 10 others of radiotherapy and was due for another 12 cycles of chemo.

“We were told she has exhausted her SHA cover. A single session costs Sh90,000. We simply do not have that kind of money. She skipped her sessions, what do we do? Cancer will not wait until SHA financial year, which we were told is October,” the caregiver told Kenco .

Another breast cancer warrior said she registered SHA in May last year and paid full annual premium of Sh12,630. in July, she paid another Sh12,630 to cover her until 2027.

“I have only used Sh108,000 – Sh53,000 for PET CT and another Sh53,000 for chemo. Recently, when I went for my second chemo session, the hospital told me my SHA had expired. I was told to pay cash. I called SHA, no one answered. Eventually, I found someone internally who confirmed that my account was valid 2027 but the hospital insisted that their system showed otherwise and told me to follow for myself. I stood my ground and told them it is their duty as an accredited facility to call SHA. Only after that did they call and I got an approval, I was in tears,” she told Kenco .

They want SHA to ensure patients’ benefits and balances reflect automatically on the Afya Yangu App and the SHA portal and hold accredited facilities accountable for delays and denials resulting from internal misalignment with SHA systems.