The Social Health Authority (SHA) has reimbursed 53 percent of claims submitted by contracted hospitals countrywide, resulting in arrears totaling billions of shillings and highlighting an escalating health financing crisis.
According to data from the SHA portal, hospitals have submitted claims totaling Sh93 billion since the portal's launch in October 2024. Of these, Sh90 billion has been verified as legitimate but only Sh50 billion has been reimbursed.
This leaves Sh43 billion unpaid, which exceeds the Sh33 billion that the defunct National Hospital Insurance Fund left unpaid.
Overall, Kenya's health sector is dealing with Sh76 billion in outstanding claims, raising serious concerns about the sustainability of health financing reform.
Despite high verification rates remaining consistent over the months, the delay in reimbursement persists, putting providers in a difficult position.
“Hospitals across Kenya are on the brink. Many have already shifted to cash-only payments; others are preparing to shut down. This crisis threatens patients, especially in underserved counties like Wajir, Mandera, Marsabit, and Samburu, where private facilities are often the only providers,” said Dr Brian Lishenga, chairman of the Rural and Urban Private Hospitals Association of Kenya (Rupha).
In less than a year, hospitals processed over 4.5 million claims. Claims volume per month increased from 84,000 in October 2024 to a peak of 642,000 in May 2025, before decreasing to 252,000 in August.
Private hospitals submitted the largest share of claims, amounting to Sh49.9 billion. Of this, approximately Sh48.6 billion has been verified, but only 53 percent has been reimbursed, leaving nearly Sh23 billion outstanding.
Public hospitals submitted claims worth Sh28.5 billion, of which Sh27.5 billion has been verified. With less than two-thirds reimbursed, they are owed approximately Sh13 billion.
Faith-based hospitals, although fewer in number, submitted claims totalling Sh5.3 billion, of which they are owed approximately Sh2.5 billion due to partial payments.
Dr Lishenga further noted that private hospitals, which provide half of all healthcare services in the country, have been hit hardest by the crisis.
“Private hospitals provide 50 percent of services in Kenya but face discrimination. Claims (especially for surgeries & inpatient admissions) are stuck in review for more than four months. Fraud controls weaponized instead of fixing flawed Proxy Means Testing and unaffordable premiums.”
“We will not remain silent while hospitals collapse under debt, patients are denied care, and universal health coverage is reduced to a political slogan,” said Dr Lishenga.
According to the Ministry of Health, as of May, more than 22 million Kenyans are registered with SHA. The figures show that over 6.3 million Kenyans aged 18–35 are now SHA beneficiaries, while 5,310,000 individuals are aged 36–55. Additionally, 4.38 million individuals are under the age of 18, and 2.5 million are over 55.
Health Cabinet Secretary Aden Duale announced that the SHA has approximately 18.5 million active registrations, with 3,642,565 clients having transitioned from the NHIF to the new health scheme.
“As of May 10, the total number of registrations is 22,165,249, with an average of 50,000 new registrations per day. On average, 25,000 Kenyans undergo means testing per day, paying an average of Sh20 million,” said Mr Duale. “The total number of individuals who have undergone means testing now stands at 4,783,546.”
