Is SHA on it's death bed?

Kenya's health financing system, particularly the National Hospital Insurance Fund (NHIF) and its transition to the Social Health Authority (SHA) under the new Social Health Insurance Fund (SHIF), is in a critical crisis, often described as "on its deathbed." This is due to a complex interplay of deep-rooted structural, financial, governance, and implementation problems: The Social Health Authority (SHA) is a project of President William Ruto. It was established in October 2024 to replace the National Hospital Insurance Fund (NHIF) as Kenya's national health insurance provider. President Ruto has actively promoted and championed the SHA as part of his government's efforts to achieve universal health coverage and provide affordable healthcare to all Kenyans. The government under his leadership has taken measures, including paying premiums for those who cannot afford them and cracking down on fraud related to the system. Corruption in the Kenya Health Authority (SHA) has been widely documented and reported. It includes massive financial mismanagement, violations of procurement laws, a lack of government oversight, and improper handling of public funds. – In 2024, the Kenyan government invested approximately Ksh 104.8 billion in the SHA system, a healthcare digitalization initiative to optimize healthcare delivery. However, the system is owned and controlled by a private consortium, posing risks to public funds and healthcare delivery. – The SHA system's procurement violated laws, including single-source procurement that bypassed competitive bidding, thus violating Article 227 of the Constitution, which mandates fairness, transparency, and cost-effectiveness. There was neither a procurement plan nor a budget framework to justify or control expenditures, which violated the Public Procurement and Asset Disposal Act. The government agreed to contracts where intellectual property and control remain with private parties. The government is prohibited from developing a competing system, raising concerns about monopolization and governance. SHA funds are managed through a trust account controlled by a private agent with unclear oversight. This increases the lack of transparency and the risk of misappropriation of public funds. There have been cases of fraudulent hospitals fraudulently claiming large sums (e.g., over Ksh 10.6 billion) from the SHA. This led to investigations by the Directorate of Criminal Investigation (DCI). Critics and stakeholders such as the Confederation of Nigerian Trade Unions (COTU) accuse the Ministry of Health and the Digital Health Authority of controlling the SHA's IT systems and limiting its independence. This, they say, impairs its ability to properly process claims and prevent fraud. Calls have been made for parliamentary inquiries, the publication of contracts, and investigations by anti-corruption agencies to hold those responsible accountable, protect public funds, and ensure transparency. While the President has publicly committed to keeping the SHA corruption-free, challenges remain. This ongoing problem seriously threatens the effectiveness of the digitalization of Kenya's healthcare system and requires urgent reforms and accountability mechanisms. Summary of SHA Challenges. 1. Chronic underfunding and financial unsustainability: - Inadequate government subsidies; - High operating costs; - Unreliable reimbursements. 2. Governance, corruption, and mismanagement: - Endemic corruption; - Weak oversight and accountability; - Political interference. 3. Poor access and poor quality of care: - Limited benefits package; - High out-of-pocket costs; - Overburdened public facilities; - Provider attrition. 4. Flawed transition to SHA/SHIF: - Rushed implementation; - Funding gap not closed; - IT system failures; - Confusion and mistrust; - Legal and political challenges. 5. Systemic weaknesses in the health sector: - Fragmented system; - Staffing crisis; - Weak infrastructure. The consequences: Hospitals are on the verge of collapse. Many public and faith-based hospitals are on the verge of collapse due to unpaid bills, unable to purchase supplies or pay salaries. Strikes by healthcare workers over wages and working conditions are common. Patients will suffer. Kenyans face longer waiting times, shortages of essential medicines, and denial of services, and must pay out of pocket despite having health insurance. The number of preventable deaths is increasing. This is leading to a loss of trust. Public confidence in the health financing system is at an all-time low. Many view contributions as a wasted tax rather than a safety net. In addition, progress towards universal health coverage is stuttering. Kenya's ambitious goal of achieving universal health coverage (UHC) by 2030 is seriously threatened by the collapse of its primary financing mechanism. Is it really "dead"?** Although the situation is serious, it is not necessarily incurable 'yet'. However, the system is in a critical state and requires 'urgent, radical, and sustained interventions' to survive: @https://www.standardmedia.co.ke/national/article/2001529454/sha-on-deathbed-crisis-as-money-taps-run-dry-at-health-scheme @https://www.citizen.digital/news/sha-a-bleeding-health-insurance-and-government-attempts-to-gain-tenacity-n368731 @https://thestar.co.ke/what-you-need-to-know-about-sha-shif-and-nhif-unmasking-corruption-in-healthcare-procurement/ @https://jhkea.org/2025/03/04/how-a-multi-billion-health-system-is-bleeding-billions-while-kenyans-die/ @https://www.kelinkenya.org/press-release-auditor-generals-findings-on-the-social-health-authority-sha-corruption-in-the-health-sector-is-murderss-release/ @https://nation.africa/kenya/news/how-rogue-hospitals-tried-to-steal-sh10-6bn-from-sha-5167340 @https://www.youtube.com/watch?v=hc5l05ZfpSE @https://www.president.go.ke/sha-will-remain-free-of-corruption-president-ruto/ @https://x.com/OkiyaOmtatah/status/1897139205374931430