NAIROBI, Kenya – Kenyan private hospitals have announced they will stop offering services under the Social Health Authority (SHA) from Monday, citing unresolved system failures and mounting unpaid claims that threaten both patient care and facility operations.
The Rural & Urban Private Hospitals Association of Kenya (RUPHA) said Thursday that its members can no longer sustain services under the new state-backed healthcare scheme due to persistent glitches and delayed payments.
RUPHA Chairperson Dr. Brian Lishenga said the government has failed to address critical issues surrounding the system, putting patients at risk and pushing hospitals toward financial ruin.
“We have unpaid debt dating back to 2017, hospitals are facing bank defaults, we have stockouts of essential medicines, and many consultants haven’t been paid for years,” Dr. Lishenga stated.
According to RUPHA, 54% of hospitals have yet to receive any payments from SHA, while 89% have reported failures in the SHA portal.
Additionally, 83% say they are struggling to verify patient eligibility due to frequent system glitches.
Among the key issues hospitals face are prolonged system downtime, delays in One-Time Password (OTP) verification, and a lack of transparency in claim approvals.
“These failures are making it impossible for hospitals to provide services, and without urgent intervention, teachers and police officers—who rely on these schemes—will be left without quality healthcare,” he warned.
RUPHA is now demanding that the government settle Ksh.30 billion in unpaid NHIF arrears and streamline the SHA outpatient reimbursement model to ensure fair and timely payments.
The association has also announced that it will no longer provide care under Medical Administrators Kenya Limited (MAKL), the administrator handling medical schemes for teachers and police officers, until the issues are resolved.
The SHA, which replaced the National Health Insurance Fund (NHIF) in October 2024, has faced backlash since its rollout.
Patients have complained of delayed approvals and denied claims, while healthcare providers have struggled with the system’s inefficiencies.
Clinical officers have also been locked in a standoff with the government, protesting their exclusion from SHA services.
They accuse authorities of breaching last year’s return-to-work agreement, which included demands for promotions, better medical coverage, and permanent employment terms.
They are now calling for immediate recognition and empanelment of clinical officers under SHA and reinstatement of pre-authorization rights for clinical officer specialists.
With mounting frustrations from both hospitals and healthcare workers, the crisis in Kenya’s public healthcare financing system appears far from over.
