More than 700 private hospitals in Kenya have rejected payments through the Social Health Authority (SHA) scheme over an outstanding Sh7 billion debt by the public health insurers. They are now demanding cash payments from patients to curb further pileup of the debt.
The Rural and Urban Private Hospitals Association of Kenya (Rupha) said that the billions of shillings owed by SHA across different service categories has crippled its members' operations.
According to the association, overall, hospitals nationwide are owed Sh43 billion directly, while a further Sh24 billion is stuck in “review”.
This brings the total debt across all facilities to Sh76 billion, including historical arrears.
“Within that, Rupha members alone have submitted claims worth about Sh14.3 billion over the past year, of which only 51 to 53 percent has been paid, leaving an outstanding balance of between Sh6.7 billion to Sh7 billion,” said Dr Brian Lishenga, the Rupha chairperson.
Rupha on Monday said it resorted to the drastic action because hospitals are struggling under the strain of unpaid claims, rejected reimbursements and liabilities dating back years.
This decision marks a significant shift from its earlier warning to potentially halt services completely on September 19, a compromise aimed at keeping facilities open but forcing patients to pay cash.
“At the heart of our call is a simple truth: hospitals must be funded so that patients can access essential supplies, equipment and personnel. Without this, universal health coverage is a hollow promise,” said Dr Lishenga.
The standoff comes just one week before SHA’s first anniversary. It was launched on October 1, 2024, to replace the National Health Insurance Fund under the Social Health Insurance Act.
The authority was launched as a flagship reform to drive universal health coverage, but Rupha has argued that it has inherited the NHIF's liabilities without a sustainable financing model, leaving hospitals in an even worse crisis.
To restore normality, the association is demanding the immediate settlement of all claims worth Sh10 million or less, verification of larger claims within seven days, reversal of mass claim rejections, creation of an independent dispute resolution tribunal, reform of SHA’s financing model to ease the burden on salaried workers, and reinstatement of downgraded beds.
