New SHA payment system: Why hospitals have a problem with Duale’s plan
The switch off threatens unpaid claims sitting with SHA during system migration, forcing Health CS Aden Duale to convene emergency talks at Afya House and extend the deadline to October 30.
Hospital owners across the country say the Government's forced migration from the Savannah Informatics-run provider portal to the new Health Management Information System (HMIS) will cost them at least Sh600,000 and up to Sh1 million annually. They are scrambling to reconfigure billing systems, retrain staff and keep patient claims moving during the switchover.
The complaints prompted an impromptu meeting on Friday, October 2, at Afya House between Health Cabinet Secretary Aden Duale and private hospital owners. It was called to explain why the migration was necessary and to contain mounting frustration in the sector.
This comes a day after the Ministry of Health confirmed that the transition had "progressed well" overall, while quietly granting facilities a one-month extension to October 30. The extension acknowledged that major gaps remained among referral hospitals, faith-based facilities and private providers.
Dr Brian Lishenga, former Secretary-General of the Rural and Urban Private Hospitals Association of Kenya, explained the mechanics behind the confusion.
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"Facilities previously submitted claims through a shared portal maintained by a consortium under Savannah Informatics. That portal is now being decommissioned entirely; the original switch-off date was set for September 30, before the Ministry granted the extension."
"That means all the claims that you make that are unpaid, they can go," Dr Lishenga said, describing the risk facilities faced if the old portal went dark before their records had been properly migrated. The underlying claims data sits with the Social Health Authority, but the portal had already stopped accepting new claims even as facilities waited for clarity on the transition.
The Social Health Authority building in Nairobi.
Under the new arrangement, the Social Health Authority (SHA) no longer runs its own claims platform directly. Instead, facilities must onboard a certified HMIS of their own, sourced from one of several accredited vendors, at their own cost.
"They need to onboard a certified HMIS," Dr Lishenga said.
"The challenge here is that it is not an on-and-off switch. First, when you move to a new system for running your business, you have to train your staff. You need to buy new equipment, new systems."
"The hospitals are incurring between 60,000 and 100,000 per year," he said of smaller facilities.
"It goes all the way to a million shillings per year for Level 4s, Level 5s. It's a lot of money."
This is not the first time facilities have had to change systems. When hospitals moved from the NHIF claims portal to Savannah Informatics, they did not pay any money. The transition was, however, marred by system hitches. Claims were not paid on time because the system took a long time to update.
The numbers suggest Kenya's digital health rollout has worked top-down in reverse. Primary care facilities, which handle the largest share of routine patient visits, have already made the switch. The country's most complex referral hospitals, and the private facilities bearing the direct cost of certification, are still catching up.
A Ministry statement issued on October 1 paints a system that is still catching up with itself.
"All 6,427 public Level 2 to 4 facilities, the bulk of Kenya's primary care network, have fully transitioned to HMIS. But only 4 of 27 public Level 5 county referral hospitals have completed the switch, with the remaining 23 at various stages. Of 518 contracted faith-based facilities, just 38 have fully migrated," the statement said.
CS Duale said even Kenyatta National Hospital and Kenyatta University Teaching, Referral and Research Hospital, the country's flagship Level 6 national referral facilities, are "expected to complete their transition by the end of next week". That is more than a month after the process began.
On the private side, the Digital Health Agency has so far certified 28 existing HMIS platforms. It plans to run Rapid Results Initiatives throughout October to speed up the remaining facilities.
The Ministry has stressed that patients will not be affected by the lag.
"No patient will be denied access to healthcare services because a facility has not yet fully transitioned to HMIS," CS Duale said. He added that facilities still lagging should "expedite the process without further delay" and engage the Digital Health Agency for technical support.
The CS and private health facility owners agreed at Friday’s Afya House meeting on a facility-by-facility transition plan, including outstanding requirements and firm completion timelines.
For hospital owners facing bills running into six figures, and in some cases seven, the question is no longer just whether the October 30 deadline will hold. It is who will ultimately bear the cost of a transition the Government has mandated but not funded.
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