Hospitals demand breakdown of Sh3.2bn SHA payments
The Social Health Authority building in Nairobi.
What you need to know:
- The majority of hospitals receiving the little payment are the national referral and county hospitals county.
- The lower-level hospitals, many of which were on-boarded late, are struggling to survive.
Healthcare providers are calling on the government to publish a breakdown of payments to hospitals and revenue collected from Kenyans since the launch of the Social Health Insurance Fund (SHIF) in October.
They cited growing frustration over delayed reimbursements and the financial strain on facilities, adding that Health ministry officials keep announcing figures that are not reflected in hospitals.
Medical Services Principal Secretary Harry Kimtai told the Nation that they had released Sh3.2 billion to hospitals and only those with technical problems had not received funds.
“We have paid over Sh3.2 billion for SHA claims. A few facilities have not received money due to technical challenges like account not matching or facilities names different from the bank details as submitted during empanelling,” Mr Kimtai said.
Providers are now calling for transparency in payments, asking the ministry to publish the names of hospitals that have now been paid and the amount.
The providers are now demanding payment transparency asking the Ministry to publish the names of the hospitals that have since been paid and the amount.
“We have not received any substantive amount for the services we’ve rendered under SHA,” said Dr Brian Lishenga, the chairperson of the Rural Urban Private Hospital Association. “Hospitals are being paid as little as Sh5, 000, which is grossly insufficient. If the government claims to have disbursed Sh3.2 billion, as they say, they should publish a breakdown of these payments.”
He adds, “We are demanding answers. We want to know not only which hospitals have been paid but also how much revenue SHA has collected from Kenyans since October.”
The majority of hospitals receiving the little payment are the national referral and county hospitals county. The lower-level hospitals, many of which were on-boarded late, are struggling to survive.
“Rural and lower-tier public hospitals are bearing the brunt of payment delays, leaving them unable to procure essential supplies or pay staff,” Dr Lishenga said.
The Social Health Act, which replaced the National Health Insurance Fund (NHIF) in October, was established to streamline health insurance and bolster universal healthcare access. However, the transition has been fraught with challenges.
“There is no cash in health facilities at the grassroots level,” Dr Lishenga explained. “Public hospitals, already overwhelmed by patient demand, are now grappling with the frustration of delivering care without the promised support.”
“Under NHIF, we knew how much was collected and which hospitals received payments,” Dr Lishenga noted. “Why is SHA so different? The lack of transparency is creating distrust among healthcare providers and threatening the scheme's viability.”
He said that if the frustration persists, hospitals will be compelled to collect cash payments from Kenyans and suspend the SHIF programme until the situation stabilises. He emphasised that hospitals are currently facing costs that may not be reimbursed by the fund.
"For SHA to achieve universal healthcare, it must promptly address these issues. We need clarity, accountability, and commitment to ensuring that all facilities, both large and small, receive timely payments for the services they provide," Dr Lishenga said.
“If there are technical issues, resolve them. The government must prioritise health facilities in underserved areas, which are the lifeline for millions of Kenyans. Publish the data, show us the breakdown of payments, and demonstrate how SHA funds are being used. Anything less is unacceptable.”
Already, the clinical officers are on strike over a new rule that has since excluded the 26,000 medics from pre-approving key medical procedures in the SHA plan. This has disrupted services in more than 1,000 facilities currently run by the professionals.
The clinical officers also claim that they have been deprived of the right to pre-authorise specialised procedures, despite playing a critical role in the delivery of health services at all levels of care in Kenya.
Mr Peterson Wachira, the chairman of the Kenya Union of Clinical Officers, said the new SHA system was forcing clinical officers to use medical officer licences to pre-authorise procedures in their facilities or obtain licences from the Kenya Medical Practitioners and Dentists Council (KMPDC), which is predominantly an organisation for medical doctors.
