Nairobi Kenya — Private hospitals have announced plans to suspend Social Health Authority (SHA) services from Monday, citing unpaid NHIF arrears, an unworkable outpatient reimbursement model, and government inaction in addressing persistent challenges.
Speaking at a press conference on Thursday, the Rural and Urban Private Hospitals Association (RUPHA) Chairperson Brian Lishenga said the ongoing system glitches and mounting arrears have led to staff losses in many health facilities.
"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.
Demands for Urgent Action
RUPHA is demanding that the government settle the Sh30 billion NHIF arrears in full. The association is also calling for a revision and streamlining of the SHA outpatient reimbursement model to ensure that facilities are adequately compensated.
Additionally, RUPHA wants the government to guarantee fair and timely payments under Medical Administrators Kenya Limited (MAKL), which manages medical schemes for police officers and teachers.
Lishenga noted that 54% of hospitals have not received payments from SHA, while 89% of facilities have reported failures in the SHA portal. He further stated that 83% of hospitals struggle to verify patient eligibility due to frequent system glitches.
As a result, from Monday, patients seeking treatment at private hospitals will be required to pay in cash, as SHA services will no longer be accepted until the government meets the association's demands.
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SHA Struggles and Government Response
Since its rollout in October 2024, SHA has faced numerous challenges, with Kenyans expressing frustration over inefficiencies and system failures. The most significant issues include prolonged system downtime, delays in One-Time Password (OTP) verification, and an inability to track claim approvals.
Deputy President Kithure Kindiki acknowledged these issues on February 17, stating that the government is committed to resolving the glitches to ensure Kenyans access quality healthcare.
"If SHA was working, we wouldn't have Kenyans complaining," Kindiki admitted.
He convened a health summit at his Karen residence, bringing together county leaders and Ministry of Health officials to discuss ways to improve SHA's accessibility and efficiency.
In response to public outcry, Kindiki announced that the Ministry of Health is reviewing the Means Testing Tool for SHA contributions to better address Kenyans' concerns.
