Over half of the health facilities contracted by the Social Health Authority (SHA) have yet to receive payments for claims submitted in the final quarter of 2024, according to a recent survey by the Rural & Urban Private Hospitals Association of Kenya (RUPHA).
The findings paint a grim picture of delayed reimbursements, financial strain, and struggling healthcare providers across the country.
The RUPHA survey, conducted between December 24 and December 31, 2024, revealed that only 42pc of health facilities received any payment for their claims, leaving 58pc empty-handed.
Even among those that did get paid, the amounts were significantly lower than expected.
Only 6pc of facilities received reimbursements covering more than 80pc of their claims, 30pc were paid less than 10pc of their submitted claims and another 22pc received only 10–20pc of their claims.
“These delays are crippling healthcare facilities across the country,” Dr. Lishenga of RUPHA stated. “Hospitals are struggling to keep their doors open.”
Mounting Debt and Strained Operations
With cash flow drying up, 96pc of surveyed hospitals reported severe financial distress, with private hospitals bearing the brunt of the crisis. The numbers speak for themselves:
- 89pc of facilities cannot meet operational costs.
- 87pc are unable to pay their staff.
- 81pc are struggling to pay suppliers.
The situation has led to shortages of essential medical supplies, delayed salaries, and an increasing reliance on loans to sustain operations. Many hospitals have warned that without urgent intervention, access to healthcare could deteriorate even further.
NHIF Arrears and a Broken Payment System
SHA’s delays aren’t the only issue—hospitals are also battling overdue payments from the National Hospital Insurance Fund (NHIF).
- 49pc of hospitals reported receiving no NHIF payments.
- 40pc received some payments, though many were incomplete.
- 11pc were unsure whether the payments they received were for past arrears.
Monthly trends offer little hope. In October 2024, only 19pc of facilities were paid, increasing slightly to 23pc in November, before dropping again to 20pc by December 24.
“The disbursement process needs urgent reforms to ensure timely and equitable payments,” Dr. Lishenga emphasized.
In response to the crisis, RUPHA has called for urgent reforms in healthcare financing.
The association is pushing for equitable and transparent payment mechanisms to prevent future delays, a streamlined reconciliation process to avoid discrepancies in claim payments and government prioritization of timely disbursements to sustain health services.
“A functional healthcare financing system is essential to delivering quality care to all Kenyans,” Dr. Lishenga concluded.
With hospitals on the brink and medical professionals working under immense pressure, all eyes are on the Kenyan government to step up and fix the cracks in the system.
