NAIROBI, Kenya- Contracted primary healthcare facilities that fail to dispense prescribed medicines to patients will receive reduced pharmacy reimbursements under a new accountability framework announced by the Social Health Authority (SHA).
In a public notice issued on July 21, 2026, SHA said the move is intended to ensure beneficiaries enrolled under the Primary Healthcare (PHC) Fund receive the full package of services they are entitled to, including prescribed medicines, as outlined in the Ministry of Health’s treatment guidelines.
The authority said it had identified gaps in medicine dispensing at some contracted facilities, where patients were receiving only part of the healthcare services covered under the PHC benefit package despite facilities receiving government funding.
“The PHC benefit package covers the complete episode of care in line with Ministry of Health treatment guidelines. This includes consultation, diagnosis, clinically indicated investigations, treatment and prescribed medicines,” the notice states.
To strengthen accountability, SHA said it will monitor each facility’s medicine-dispensing performance through the Digital Health Agency platform and align reimbursements with the actual services provided.
Under the new payment model, SHA will first determine each facility’s monthly reimbursement using the existing weighted global budget capitation formula.
A fixed portion of that allocation will be earmarked for pharmacy services, while the remaining funds will cater for consultations, staff salaries, diagnostics, consumables, overheads and other operational costs.
The authority will then calculate each facility’s medicine-dispensing rate by comparing the number of medicines dispensed against those prescribed and recorded in the approved digital system.
Using the formula Medicines Dispensed ÷ Medicines Prescribed, facilities that dispense all prescribed medicines will receive the full pharmacy component of their reimbursement. However, those dispensing only part of the prescribed medication will receive payment proportional to their dispensing rate.
For example, a facility with a dispensing rate of 80 per cent will receive only 80 per cent of the pharmacy reimbursement, with the remaining 20 per cent deducted. SHA clarified that the non-pharmacy portion of the payment will remain unaffected.
The authority said the approach is designed to reward healthcare providers that consistently supply prescribed medicines while ensuring public funds correspond to the actual level of care delivered.
The directive forms part of broader reforms under Kenya’s Social Health Insurance framework, which seeks to improve access, accountability and quality of healthcare services through digital monitoring and performance-based financing.
The reforms are anchored in the Social Health Insurance Act, 2023, which established SHA to replace the National Health Insurance Fund (NHIF), and are implemented alongside the Digital Health Act, 2023, which supports electronic health records and digital service monitoring.
SHA urged all contracted primary healthcare facilities to provide the complete package of care and accurately document medicines dispensed through approved systems to safeguard patient access to essential treatment and ensure compliance with reimbursement requirements.
The notice was signed by SHA Chief Executive Officer Dr Mercy Mwangangi, who advised healthcare providers requiring clarification to contact the authority through its toll-free line or official communication channels.