NAIROBI, Kenya — The Social Health Authority (SHA) has completed tariff negotiations with Level 5 and Level 6 hospitals under the Public Officers Medical Scheme Fund (POMSF), marking a significant step in the rollout of the new healthcare financing framework.
In a statement issued Sunday, SHA Chief Executive Officer Mercy Mwangangi said the authority is now moving to the next phase, which will focus on Level 4 and Level 3 health facilities.
“As a result, SHA has commenced the required market analysis and tariff negotiations under POMSF. So far, negotiations with Level 5 and Level 6 facilities have been completed, and the next phase will focus on Level 4 and Level 3 facilities,” she said.
The authority said the approved tariffs will be implemented progressively within the SHA claims system, structured by hospital level and service packages. The framework will guide service access, claims submission, adjudication, and reimbursement under POMSF.
SHA assured that facilities that have accepted the negotiated tariffs will continue offering services to beneficiaries without disruption.
“Facilities that have accepted the negotiated tariffs will continue providing services to POMS beneficiaries in line with the approved benefit package and agreed reimbursement terms,” the statement added.
The development comes amid heightened scrutiny of the scheme following recent enforcement actions by the Ministry of Health. Last week, Health Cabinet Secretary Aden Duale announced the suspension of 12 health facilities over fraudulent claims flagged by forensic auditors.
Duale said the government would intensify oversight to safeguard public funds, warning that political influence would not shield facilities found culpable.
“I want to tell the owners of these facilities that political parties will not help you… we have a duty to protect public resources,” he said during a forum in Garissa.
According to the ministry, at least 24 facilities are currently undergoing forensic audits over suspected irregular claims under the SHA system.
The dual-track approach—rolling out structured tariffs while tightening enforcement—reflects broader reforms aimed at improving efficiency, accountability, and sustainability within Kenya’s public health financing model.
Health sector analysts say successful implementation of POMSF tariffs will be critical in restoring provider confidence, ensuring timely reimbursements, and stabilising service delivery under SHA, particularly as the government transitions from previous insurance frameworks.
The authority maintains that the phased rollout is designed to ensure a smooth transition while aligning reimbursement structures with actual service costs across different levels of care.
