Taita Taveta Senator Johnes Mwaruma has challenged the government and the Social Health Authority (SHA) to provide an immediate explanation for a controversial rule denying Kenyans access to medical care despite making partial contributions to the new scheme.
The Senator highlighted widespread public panic and frustration stemming from the SHA's rigid requirement for a full year of upfront payments.
During a session before the Senate Committee on Health on Tuesday, July 22, Senator Mwaruma pressed for clarity on why ordinary citizens, particularly those in the informal sector, are being turned away from vital medical services.
He underscored the fundamental injustice of denying healthcare to individuals who have already committed their hard-earned money to the Social Health Insurance Fund (SHIF).
The Senator cited Section 18(1) of the Social Health Insurance (General) Regulations, 2024, which mandates annual contributions for households not in salaried employment, calculated at 2.75 per cent of their household income.
He argued that while the regulation specifies annual contributions, its current implementation effectively locks out countless Kenyans who cannot afford a lump-sum payment and are paying in instalments.
According to the Senator, this situation undermines the fundamental rights enshrined in Article 43(1)(a) and 43(2) of the Constitution of Kenya, 2010, which guarantee every person the right to the highest attainable standard of health, including the right to health care services.
Mwaruma asked the Health Committee to urgently explain the rationale behind denying medical services to patients who have not completed a full year of contributions, even in instances where the patient’s contributions are up to date at the time of seeking treatment.
He also asked the committee to provide clarification about the government's position on the directive and the measures in place to address the matter.
Mwaruma asked the committee to also clarify whether personal data from the National Hospital Insurance Fund (NHIF), including contributor identity and contribution history, was successfully migrated to the SHA's system.
Government officials have defended the rule, stating that asking for full-year contribution helps to prevent gaps in coverage, mostly for those with erratic incomes.
Public Health Ps Mary Muthioni said that paying in advance ensures services are uninterrupted even if someone falls ill or their income is disrupted.
