Public servants enrolled under the Social Health Authority Public Officers Medical Scheme Fund (SHA POMSF) are raising concerns over what they describe as repeated delays in accessing medical procedures at The Nairobi West Hospital, despite the facility being listed as a contracted provider under the scheme.

The allegations, have prompted calls for the Social Health Authority (SHA) and the hospital's management to clarify the status of services offered under the public officers' medical cover.

According to the whistleblower, affected patients first contact the hospital to confirm whether it accepts SHA POMSF. They say the hospital confirms that it does, books appointments and allows patients to consult specialists.

The frustration, the complainant says, begins after the consultation.

According to the whistleblower, patients who are advised to undergo surgery or other medical procedures are allegedly informed that the procedure cannot proceed immediately and are told they will be contacted later for a new date.

The complainant says many patients are left waiting for weeks without clear communication on when their treatment will take place.

One of the messages shared with this publication states:

"Dear patient, we are writing to inform you that your planned procedure has been temporarily postponed... We are actively working on the new schedule... We will call you to plan."

According to the complainant, patients are verbally informed that the delays are due to a resource shortage because SHA has allegedly not settled pending payments to the hospital.

The whistleblower questions whether patients paying cash would face the same delays.

The complainant argues that if procedures are available for self-paying patients but repeatedly postponed for insured patients, it raises concerns about whether public servants under SHA POMSF are receiving equal treatment.

The employee says many public officers contribute to the medical scheme every month with the expectation that they will receive treatment when they need it.

Instead, some now find themselves postponing important procedures, seeking treatment elsewhere at their own cost or continuing to live with untreated medical conditions.

The complainant also questions why patients are not informed of any limitations before attending appointments.

According to the whistleblower, if there is a dispute over payments between the hospital and SHA, patients should be informed before they spend time and money attending consultations only to discover later that their procedures have been postponed indefinitely.

The concerns now place responsibility on the Social Health Authority, led by Chief Executive Officer Dr Mercy Mwangangi, to clarify whether there are any payment issues affecting services under the Public Officers Medical Scheme Fund at Nairobi West Hospital.

Questions are also likely to be directed at the management of The Nairobi West Hospital, asking whether services under SHA POMSF remain fully available and, if not, why patients continue to be booked for consultations without being informed of possible delays.

The matter may also require attention from the Ministry of Health, led by Cabinet Secretary Aden Duale, and Principal Secretary for Medical Services Dr Ouma Oluga, given that the concerns involve access to healthcare by public servants under a government funded medical scheme.

Below is the complaint received.

Dear Cyprian. Kindly hide my identity.

I’m writing to bring to your attention serious frustrations being faced by public servants under the SHA-POMSF scheme who are seeking medical services( admissions for medical procedures) at The Nairobi West Hospital.

1. The Facility is contracted: The Nairobi West Hospital is listed and contracted by SHA to offer services under the POMSF - Public Officers Medical Scheme Fund cover.

2. Misleading communication: When patients call to inquire if the hospital accepts POMSF, the facility confirms they do and even proceeds to book appointments

3. Denial of services after consultation: After seeing the doctor and being recommended for procedures, admission, or treatment, patients are then told: _“The procedure cannot be done now. We will call you.”_ Patients end up waiting indefinitely. The reason given is “lack of resources because SHA has not paid us.”

What we wonder is whether, if you have cash, the same treatments could be postponed " due to lack of consumables"? Or are the same procedures done immediately?. This creates a clear case of discrimination against insurance patients.

4. Lack of transparency from SHA and the Hospital: SHA has not communicated to public officers whether there is a dispute with Nairobi West. The hospital also does not inform patients in advance that POMSF is not being honored. Many of us feel this is an indirect way of saying they no longer accept SHA-POMSF, but without officially saying so.

Public servants who pay for POMSF monthly are being forced to pay out of pocket, delay critical treatment, or go without care despite having active cover.

We are requesting media attention to: 1. Ask SHA to clarify the status of Nairobi West Hospital under POMSF 2. Ask the hospital to be transparent with patients before booking 3. Stop the discrimination between cash and insurance patients

We have WhatsApp messages, appointment bookings, and recorded experiences to support this.

Kindly help amplify this so that public servants can get the healthcare they are entitled to.