Legislators have raised concerns over the sustainability of the Social Health Authority (SHA) as most Kenyans are appearing to be reluctant towards paying the monthly contributions despite the ministry reporting a 20.2 million registration.

Robert Pukose, the National Assembly Health Departmental Committee chair, said only 3.3 million Kenyans – those employed – are making their contributions to the platform, a factor that raises concerns even as president William Ruto claimed that the system would work. The remaining Kenyans usually, make the first payment when they fall sick thereby becoming a challenge to the Authority.

Because of this factor, the chair mentioned that in the next committee meeting, they are going to reintroduce that three-month consecutive contribution threshold before getting the SHA services that will help cushion the system from further facing funding issues as was the case with the defunct National Health Insurance Fund (NHIF).

“This is a big factor that is facing the system and we are going to have a discussion with the Ministry of Health to determine the way forward,” Pukose said.

“Also, in our next departmental committee meeting we shall be having the amendments to have the three months contributions threshold. The issue with the NHIF is that this was not enacted, we are now going to take this path,” he said.

The legislator also noted that the system has not been working for some Kenyans because of the last-minute payment which in many cases lags before becoming functional.

“The issue is that most patients pay for the services when they fall sick and that’s why you will hear most of them complaining that SHA is not working. Those who have been enrolled in the system for a while have a different tale,” he explained. “Some people are also tainting the picture of SHA because they have been unable to milk funds from it compared to the previous roll out.”

Hospitals claims

Meanwhile, Kenyans President William Ruto last week issued a Sh10 million pay to all hospitals claims that was owed to them by NHIF with hospitals having huge claims undergoing verification for a period of up to 90days as part of the plans to restore sanity in the country’s healthcare sector. “To comprehensively deal with this challenge the government has resolved to pay all hospitals with total claims of Sh10 million and below in full representing 91 per cent of all facilities that were contracted by NHIF,” he said.

Ruto added that all claims under SHA will continue to be paid within a month as a task force to verify the claims is being constructed. This was after private hospitals and faith based health facilities limited the services they were offering under the contentious SHA provisions.

Brian Lishenga, the chairman of the Rural and Urban Private Hospitals Association of Kenya (RUPHA) said 89 per cent of hospitals reported that the SHA claims portal remains non- functional, making it impossible to process reimbursements. He said hospitals cannot track claims, leading to massive payment delays.

Lishenga spoke when RUPHA declared indefinite suspension of SHA services due to unpaid arrears and unworkable outpatient reimbursement model.

RUPHA announced a suspension of services under the authority insurance scheme beginning February 24. Following the assurance by the president, the association resumed offering services to the patients as per the provision of the system.