Healthcare facilities under the Rural & Urban Private Hospitals Association of Kenya (RUPHA) and Kenya Association of Private Hospitals (KAPH) suspended Social Health Authority (SHA) and the Medical Administration Kenya Limited (MAKL) services in February 2025. The suspension, they said, was due to unpaid bills and an unsustainable reimbursement model.
We dissect the pending bills, how they came about and what steps have been taken to resolve the situation. The government owed hospitals about Ksh30 billion in arrears from the now defunct National Health Insurance Fund (NHIF).
According to SHA, out of the Ksh30 billion, almost Ksh9 billion was settled between July and mid-October 2024. The pending claims were historical, dating back 9 years.
Due to the pending bills, the Associations also spoke of financial distress stating that hospitals had lost staff, defaulted on loans and faced medicine shortages, challenges that endangered patient care and hospital sustainability.
The government, in a statement published online, promised to pay all hospitals with NHIF claims below Ksh10 million. However, hospitals with claims above Ksh10 million will undergo a verification exercise that should be completed within 90 days.
9,000 health facilities are contracted under SHA, out of these:
- 334 are under the Kenya Association of Private Hospitals
- 650 facilities are under the Rural & Urban Private Hospitals Association of Kenya
- 1300 facilities are under the Christian Health Association of Kenya
Claims that have been submitted under the Social Health Authority have been paid to a tune of 18.2 billion shillings from its roll-out in October 2024 to February 2025.
Despite the suspension of SHA services by Private hospitals, guidelines were put in place for hospitals to continue offering emergency services and to honour existing SHA-funded inpatient admissions and scheduled outpatient appointments.
