NAIROBI, KENYA — Private healthcare providers are poised to discontinue services under the Social Health Authority (SHA) starting Monday, expressing deep concern over substantial outstanding payments from the former National Hospital Insurance Fund (NHIF), a flawed outpatient reimbursement structure, and what they perceive as a lack of government intervention in addressing critical issues.
During a Thursday press briefing, Brian Lishenga, Chairman of the Rural and Urban Private Hospitals Association (RUPHA), articulated that persistent technical malfunctions within the system, coupled with escalating unpaid dues, have precipitated workforce reductions across numerous healthcare institutions.
The hospitals are stating that the current system is not workable, and that without immediate resolutions, they will be unable to continue providing services.
“The relevant authorities have ignored the challenges facing this new healthcare system, putting patients’ lives at risk and threatening the survival of hospitals due to weak service provision,” Lishenga said.
He revealed that hospitals are struggling with unpaid debts dating back to 2017, leading to bank defaults, stockouts of essential medicines, and non-payment of consultants for years.
“Without urgent intervention, teachers and police officers will be left without quality healthcare,” he added.
Urgent demands for a system overhaul
The Rural and Urban Private Hospitals Association (RUPHA) has issued a firm ultimatum, demanding immediate government intervention to avert a healthcare crisis. Their primary demand is the full settlement of the Sh30 billion owed by the former National Hospital Insurance Fund (NHIF).
Additionally, RUPHA insists on a comprehensive overhaul of the Social Health Authority (SHA) outpatient reimbursement model, ensuring fair and adequate compensation for healthcare providers.
The association also seeks a solid guarantee of consistent and timely payments under Medical Administrators Kenya Limited (MAKL), which manages vital medical schemes for police officers and teachers.
Chairman Brian Lishenga revealed alarming statistics, highlighting the system’s breakdown: 54% of hospitals have yet to receive any payments from SHA, and a staggering 89% report persistent failures within the SHA portal. Furthermore, 83% of facilities face significant challenges in verifying patient eligibility due to recurring system glitches.
In response to this critical situation, RUPHA has announced that effective Monday, private hospitals will transition to a cash-only payment system for patients.
SHA services will be suspended indefinitely until the government fully addresses the association’s demands, restoring stability and functionality to the healthcare system.
SHA’s troubled launch and government pledges
The Social Health Authority (SHA), implemented in October 2024, has been plagued by significant operational challenges, sparking widespread public dissatisfaction. Citizens have reported persistent inefficiencies and systemic failures, notably prolonged periods of system unavailability, frustrating delays in One-Time Password (OTP) verification, and the inability to monitor the progress of claim approvals.
Also Read: Kenya’s president Ruto promises to address SHA challenges
Acknowledging the severity of these issues, Deputy President Kithure Kindiki, on February 17th, publicly affirmed the government’s commitment to rectifying the identified glitches. He pledged that the administration will take decisive action to ensure that all Kenyans have access to reliable and high-quality healthcare services through the SHA framework.
“If SHA was working, we wouldn’t have Kenyans complaining,” Kindiki admitted.
In an effort to address the mounting concerns surrounding the Social Health Authority (SHA), Deputy President Kithure Kindiki convened a high-level health summit at his Karen residence. The summit brought together county leaders and Ministry of Health officials to strategize on enhancing SHA’s accessibility and operational efficiency.
Furthermore, responding to widespread public criticism, Kindiki announced that the Ministry of Health has initiated a comprehensive review of the Means Testing Tool used for SHA contributions. This review aims to refine the policy and better align it with the needs and concerns of Kenyan citizens.
