Jennipher Nanjala’s third pregnancy turned dangerous this spring when her water broke, spilling out in a greenish color, but she didn’t feel labor pains. The 42-year-old traveled more than 20 miles by public transit to St. Mary’s Mission Hospital—the country’s oldest missionary hospital, founded in 1932—in Mumias, Kakamega County, in western Kenya.
A clerk checked Nanjala’s national identification card to see if she had registered under the new Social Health Authority (SHA) insurance fund. She had, so the hospital cleared her to start treatment without paying cash upfront. Then the doctors examined her. Nanjala’s blood pressure was critically high.
“When I was told the baby was not kicking and she had defecated in the womb and I couldn’t go to the labor room to push, I called my husband to ask my pastor to pray for me,” said Nanjala. Doctors performed an emergency cesarean section and delivered her baby girl, Risper, alive. Three months later, Nanjala took Risper back to St. Mary’s to get a vaccination—only to find the gates closed. The hospital had shut down.
Weeks before Nanjala gave birth, faith leaders warned of imminent hospital closures due to debts owed by the defunct National Health Insurance Fund (NHIF) and fallout from slow SHA payments. The Christian Health Association of Kenya called on the government to reimburse faith-based hospitals within 14 days, but delays continued. Debts under SHA piled up, paralyzing St. Mary’s operations.
In late June, around 100 staffers went on strike because they hadn’t received paychecks in over four months. On July 1, the hospital stopped operating, unable to pay workers or purchase equipment and drugs. National news reported the Kenyan government had failed to pay St. Mary’s more than 180 million Kenyan shillings ($1.4 million USD) since the SHA insurance fund’s October 2024 rollout.
The shutdown left an estimated 300 patients without regular care and more than 200 staffers without jobs. As of August, more than 700 private and faith-based hospitals are fighting to avoid shutdowns due to SHA debts. The Rural and Urban Private Hospitals Association warned that health care facilities will have to suspend services or require patients to pay if the government fails to cover bills within 14 days. Faith-based organizations provide 40 percent of Kenya’s health care.
Kakamega senator Bonny Khalwale, a medical doctor, blamed St. Mary’s closure on President William Ruto’s poor rollout of SHA. Ruto replaced the nearly 60-year-old NHIF system with the stated aim of providing affordable health coverage under a more efficient program. SHA mandates that every Kenyan over age 18 register to receive services at any public hospital. Just under half of Kenya’s population has registered for SHA so far.
Individuals must pay a lump sum annually to register for SHA. Formal employees have 2.75 percent of their salaries withheld to cover the cost, but gig workers struggle to pay the annual fee. Without SHA registration, patients cannot receive services at public hospitals. If patients don’t have cash on hand to pay for SHA registration, public health care providers can’t treat them. Private or religious hospitals let unregistered patients pay cash.
Nurse Caroline Moracha said the public hospital where she works stays mostly empty: “We just go and sit up [till] evening. Patients don’t come, because when they come, you ask them, ‘Do you have SHA?’ If not, you send them away to go and register first.”
Because of the quick rollout, some patients’ names don’t show up in the system. Zadock Mwanzi—a public health promoter who registers villagers for SHA—signed up right away. When his daughter needed a hernia operation, staff at Kakamega County Teaching and Referral Hospital couldn’t find his SHA records. He said the hospital detained his daughter for two weeks until he gathered the cash for the bill. Such detentions are common but not legal.
Julius Wakukha, a motorcycle rider in Kakamega, had to fundraise to get his wife and their newborn twins discharged. A hospital had forced them to stay for six weeks because the babies were underweight, then insisted he pay his whole SHA annual fee upfront.
“Then the bill was too high, and I was told to pay the extra amount [for services] because SHA could only pay a certain percentage,” Wakukha told CT.
Kakamega General Hospital denied Margaret Imbenzi’s daughter admission to the labor ward to give birth unless she paid her annual SHA fee: “I had to rush her to a private hospital. Because you are saving a life, you can’t sit there waiting for the system to approve you.”
SHA also faces concerns about corruption. Earlier this year, Auditor General Nancy Gathungu told the Kenyan Parliament she found legal violations in the purchase of SHA’s 104 billion Kenyan shilling ($803 million USD) health information technology system. Senator Okiya Omtatah from Busia County, Kenya, claimed some employees running the technology received salaries of 5 million shillings per month (about $39,000 USD)—higher than the Kenyan president’s 1.4 million shilling salary (about $11,000). Daily Nation reported some payments going to nonexistent or nonfunctioning “ghost” hospitals.
Brian Lishenga, chairman of the Rural and Urban Private Hospitals Association, accused Health Cabinet Secretary Aden Duale of mishandling fraud investigations and said SHA has accumulated a debt of 43 billion shillings ($332 million USD) in just ten months. Duale said the government has uncovered fraud at 24 health facilities and is investigating 61 others.
Duale has also said the government is working to pay all outstanding debt to St. Mary’s Mission Hospital and other affected hospitals so they can reopen, on one condition: “We will work on a verification process. Minus verification, I will not pay.”
After finding St. Mary’s closed, Jennipher Nanjala tried going to a public hospital in Kakamega. Hospital staff wanted her to pay the annual SHA premium before they would vaccinate baby Risper or treat Nanjala for high blood pressure. Nanjala couldn’t, so she returned home and sold a few chickens. She used the money to go to a private hospital the following day.
Nanjala said she hopes the 93-year-old mission hospital will reopen: “All my family has been using the hospital. We were all born there, and all my children were born there.”
