SHA support falls short as family struggles to raise Ksh.1.5M for daughter's surgery

Shantel, who suffers from a congenital heart condition, requires surgery that is not available in Kenya. The family is turning to overseas medical care in hopes of saving her life. 

However, the Ministry of Health has stated that the Social Health Authority (SHA) can only provide Ksh 500,000 for overseas treatment under its healthcare benefits package, which is capped at this amount per beneficiary per year. 

While Shantel’s treatment in India will cost a total of Ksh 2 million, the SHA coverage will only cover part of the expenses, leaving the family with a significant shortfall.

"Shantel’s survival depends entirely on our ability to raise the remaining Ksh 1.5 million for her surgery," said a family member, who explained that they have already sold land to raise part of the funds. "Tumeuza shamba tumemaliza" (We have sold our land and exhausted all options), the relative shared, highlighting the financial strain the family is under. 

Shantel was referred to India for surgery because the procedure she requires cannot be performed in Kenya. Dr. Harry Mutai, Principal Secretary for Health, confirmed to Citizen TV that no hospital in Kenya, public or private, is capable of carrying out the necessary operation. 

"Her case is genuine, and the referral was warranted," Dr. Mutai explained.

Under SHA and Ministry of Health regulations, a beneficiary qualifies for overseas treatment if they are a registered and paid-up SHA member, the treatment is unavailable locally, and the healthcare facility to which they are referred is contracted by SHA. 

For Shantel's family, this means that they will receive the Ksh 500,000 available through SHA, but will still need to secure the remaining funds to afford the treatment in India. 

The family, like an estimated 18 million other Kenyans registered with SHA, has been contributing to the healthcare fund in the hope that such medical situations would not lead to financial ruin. 

However, despite these contributions, the family finds themselves facing a financial gap that could jeopardize Shantel’s chance of receiving treatment.

The government has consistently encouraged the uptake of SHA, with the hope that it would serve as a solution to such healthcare challenges. 

President William Ruto recently emphasized the need for universal health coverage (UHC) to ensure that all Kenyans have access to healthcare, regardless of their financial situation. 

"We will have health insurance for all. We cannot continue with a system where only a few can afford treatment, while others are forced to sell their land or cattle to access healthcare," President Ruto stated. 

UHC in Kenya is implemented through three funds: the Primary Healthcare Fund, the Social Health Insurance Fund (SHIF), and the Emergency, Chronic, and Critical Illness Fund. 

Salaried Kenyans contribute 2.75% of their salary to SHIF, which was designed to alleviate the financial burden of healthcare costs.

For Shantel and her family, however, that support may not be enough. 

With the remaining Ksh 1.5 million still needed for treatment, the family may have to rely on public fundraising, or "harambee," to bridge the gap and secure Shantel’s surgery. 

As the family works tirelessly to raise the necessary funds, they are hoping that the community will come together to help give Shantel a fighting chance at life.