Time flies with great content! Renew in to keep enjoying all our premium content.
Prime
Shaky digital platform remains bane of SHA
Cancer patients protesting outside Afya House, where they presented a petition calling for improved oncology package under Social Health Authority (SHA).
Approximately 81 percent of healthcare facilities across the country are dissatisfied with the Social Health Authority’s (SHA) digital system, revealing frustration over frequent downtime, delayed reimbursements, and unreliable integration, which have disrupted service delivery and strained hospital cash flow.
The nationwide assessment, conducted by the consortium of healthcare providers comprising the Kenya Healthcare Federation the Kenya Association of Private Hospitals (Kaph), the Rural and Urban Private Hospitals Association (Rupha), and the Christian Health Association of Kenya (CHAK) shows that, one year after replacing the National Hospital Insurance Fund (NHIF), the SHA digital platform remains unstable.
The findings indicate that 92 percent of health facilities have experienced repeated portal outages, while two-thirds face serious challenges in validating claims.
Only 40 percent of hospitals received claim approvals within two months, with nearly half having to wait more than three months for these approvals.
“The delays have forced hospitals to rely on credit. Many private and Level 3 facilities are borrowing just to survive. Some have reduced services, laid off staff, or even closed entirely due to cash flow crises," the report stated.
Earlier this year, hospital associations raised concerns about persistent outages that made it impossible to verify patient eligibility or process claims. Several facilities reverted to manual entry, and some patients were required to pay out of pocket even though they had coverage.
In August, SHA suspended over Sh3 billion claims citing missing documentation, and introduced a 'Missing Documents Resubmission Module', giving hospitals two weeks to upload the required documents or risk having their claims rejected permanently.
Although this was intended to improve accountability, the consortium report claims that it increased the administrative workload and caused further delays to payments.
However, Health Cabinet Secretary Aden Duale has defended SHA's digital infrastructure, terming the disruptions as a necessary part of reform, and argues that the system’s analytics are uncovering long-standing malpractice that went unchecked under the NHIF.
“This is not a system failure. It is the system functioning as intended to detect, prevent, and eliminate corruption in healthcare," said Mr Duale.
He added that SHA has rejected more than Sh10.6 billion worth of fraudulent or non-compliant claims, shut down over 700 non-compliant facilities, and downgraded around 300 others for failing to meet operational or documentation standards.
“The system had also revealed complex fraud schemes, including upcoding, falsifying records, misclassifying outpatient cases as expensive inpatient claims and sharing pre-authorisation codes, some of which had been used hundreds of kilometres away from the originating doctor,” he said.
While hospitals agree that fraud needs to be tackled, many claim that the current system undermines legitimate operations.
Weakened service delivery
“Legitimate claims are often flagged or rejected due to minor clerical errors, and smaller facilities lacking robust IT systems struggle to keep up with repeated data uploads. The outcome is that an anti-fraud system meant to enhance accountability has, in practice, slowed down reimbursements and weakened service delivery,” said Dr Brian Lishenga, chairman of Rupha.
The financial strain has led to drastic measures being taken across the health sector. About 78 percent of facilities have expressed liquidity concerns and are now seeking loans to cover cash gaps related to SHA.
Over half of these facilities have warned that they could not survive for more than three months without improved payments, exacerbated by unpaid NHIF arrears, with 73 percent of hospitals still awaiting reimbursement from the defunct fund.
Overall, nearly three-quarters of healthcare providers believe that SHA has performed worse than the NHIF in its first year, with only 11 percent stating that it has improved.
