SHA crisis: Hospitals accumulate huge debts from unremitted capitation
The Social Health Authority building in Nairobi.
Hospitals are reeling under debts running into billions of shillings due to unremitted capitation by the defunct National Hospital Insurance Fund (NHIF), despite assurances by President William Ruto that the government would pay Sh3.7 billion by last week.
The woes of both public and private hospitals in the country have been compounded by the fact that the Social Health Authority (SHA) has yet to remit funds for patients treated at health facilities in the last two months.
This comes as the Kenya Union of Primary Education Teachers (Kuppet) called for an immediate review of the requirements for patients to be referred by a public health centre to benefit from the SHA's insurance cover- renamed Taifa Care.
The stringent conditions have led to patients being turned away from private and public hospitals after failing to raise money to pay for their treatment.
Most hospital administrators were reluctant to speak on the record about the debt for fear of government reprisals.
“I can assure you that hospitals are heavily indebted, but we do not want to be victimised by the government for appearing to hit at it for a programme the President wants to succeed by all means,” An official of the Christian Hospitals Association of Kenya (CHAK) said.
He said “The problem with this programme is that it was implemented without it being piloted and hospital managers are afraid the NHIF bills may not be paid to them in full. We have bills to pay, drugs to requisition from suppliers, staff waiting for salaries and patients to treat”
Universal Health Coverage
“The President should listen to the issues raised by patients and hospitals and streamline the areas that are not working well so that we have a system that caters for all under the Universal Health Coverage (UHC) program,” The CHAK official said.
Dr Russ White, the Director of the Cardio Thoracic Centre at AGC Tenwek Hospital in Bomet County said the institution was looking forward to remittance of the NHIF dues.
“We have not received Sh560 million the NHIF owes the hospital in what has affected service delivery to the patients. Release of the money would go a long way in easing the pain patients have been subjected to,” Dr White said.
Dr White said the institution was dependent on the government for the funds to ease the pressure on piling debts with emergencies arising requiring patients to be treated to save their lives.
“Here at the CTC in AGC Tenwek Hospital, it is a matter of life and death for the patients we are handling with hundreds lined up for surgeries,” Dr White said.
Dr Ruto had assured the hospital's board, chaired by Africa Gospel Church Bishop Dr Robert Langat, during the opening of the Sh4.5 billion Cardio-Thoracic Centre on October 24 that at least Sh200 million of the NHIF dues would be paid.
Last Sunday, President Ruto announced during an interdenominational church service at Kipsitet in Kericho County that the government would pay Sh3.7 billion within the week to ease the pressure in hospitals on the NHIF debts.
He revealed that NHIF had paid Sh5 billion in pending bills to public and private hospitals in the country.
“This week, SHA will pay all the bills in hospitals incurred in the last one month to ensure that the medical services are available for all without hospitals complaining of inability to treat patients on claims of pending bills,” Dr Ruto said on November 24, 2024.
However, a spot check in most of the hospitals shows that the money has not been remitted to clear the debts.
“I have followed the NHIF (system) since 2013 and I can assure you that the new system under SHA will succeed. Failure is not an option for us,” Dr Ruto said
He stated “My position is that we will ensure that every Kenyan who is employed or not has access to medical treatment without discrimination. Failure is not an option”
“It is important for all Kenyans to register under SHA to access treatment and enable the government to plan for what is required in terms of personnel, medicine and equipment required in health facilities,” Dr Ruto said.
The President stated that despite the criticism over the SHA rollout, the government will not revert to the old system (NHIF).
It comes as the Kenya Union of Post-Primary Education Teachers (Kuppet) called for an immediate review of the pre-conditions given to patients seeking medication under the Social Health Authority (SHA).
The authority, whose medical insurance cover has been renamed Taifa Care, has seen thousands of patients turned away in public and private hospitals due to stringent conditions that have to be met.
Key among them is that for one to benefit from the insurance cover, he/she must have been referred from a health centre or dispensary – a demand that has eroded the people’s confidence in the new government medical insurance cover.
Mr Ronald Tonui, the Kuppet assistant national treasurer, Mr Edward Obwocha, the Secretary for secondary schools, Mr Sammy Chelanga, the secretary for tertiary institutions, Mr Paul Kimetto, the Bomet branch secretary and his Kericho counterpart Ms Mary Rotich said there was a need for an immediate review of the conditions to save lives.
The unionists said the pre-conditions for treatment had locked out thousands from access to Universal Health Coverage (UHC) that the government sought to strengthen under SHA.
“With the rebranding of the SHA medical insurance cover as Taifa Care, there is a need to re-look at the demands for patients to first be registered and referred from a health centre. The facilities are not only far apart, but most of the medical cases do not require one to visit a primary health facility for treatment,” Mr Tonui said.
Mr Tonui said: “Thousands of patients have, ahead of the SHA rollout, been undertaking treatment in certain public and private hospitals on existing medical conditions and do not necessarily need to go to health centres. This is a matter that needs to be addressed with the urgency it deserves.”
Speaking during the Bomet branch executive annual meeting on Saturday, Mr Tonui said the outpatient services under SHA should be restored in all private hospitals to save lives as opposed to confining them to public hospitals.
Thousands of patients covered by SHA have been turned away in private hospitals for lack of referrals from government facilities for the last two months.
They are forced to pay cash to access medical treatment in private facilities, yet under the defunct National Hospital Insurance Fund (NHIF) they were able to get treatment.
Poor hospitals
“Teachers’ medical cover is not working as expected. The teachers lost their medical allowances yet they have an inferior medical cover under the SHA and the AON-Minet cover. They are ready to go to the streets and demonstrate even without being organised by trade unions,” Mr Obwocha said.
“It is not fair for teachers to lose medical allowances in their pay slips and still get taxed 2.7 percent under SHA yet the services they get in hospitals are poor. Teachers like other Kenyans are dying in their thousands for lack of medical attention due to measures put in place by the government,” Mr Obwocha said.
“We do not want teachers to be subjected to schemes that are not beneficial to them and their families. We have AON Minet and we are again forced to pay for SHA – yet both of them are not beneficial to them,” Mr Chelanga said.
Ms Rotich and Mr Kimetto said the patients should be set free to seek medical services from facilities of their choice as opposed to being confined to poorly managed government health facilities.
“President Ruto should listen to the appeal from Kenyans of all walks of lives on the challenges faced in the rollout of SHA and seek to fix them to ease the pain of patients and save lives from being lost for lack of treatment in hospitals,” Ms Rotich said.
“The challenges faced in the last two months in hospitals with the implementation of SHA should be reason enough to quickly re-look at the issues and resolve them as Kenyans are suffering,” Mr Kimetto said.
They said the government should have automatically transferred details of those covered by NHIF to the SHA and strengthened the services and loopholes without subjecting them to referral requirements, as each medical case is unique.
Most of the public health facilities in the country do not have enough specialists, are perennially without drugs and are congested as compared with the private ones which have better services and are a preference to many.
