KMPDU deputy SG Miskellah: Reliance on private hospitals threatens SHA sustainability
By Cy Muganda, September 3, 2025Kenya Medical Practitioners and Dentists Union deputy Secretary General Dennis Miskellah has warned that the Social Health Authority will remain unsustainable as long as a large number of Kenyans continue to seek treatment in private hospitals.
Speaking on a local station on September 3, 2025, Dr Miskellah said the system was designed to meet the needs of Kenyans, but the heavy reliance on private facilities undermines its long-term viability.
“As long as the numbers of patients in Kenya, that’s for you to get proper treatment, you have to go to a private facility; SHA will never be sustainable,” he said.
Design flaws
According to Miskellah, SHA’s conception ignored critical principles of social insurance, particularly adverse selection and moral hazard issues.
He explained that allowing people to register and seek treatment immediately after falling sick creates financial losses similar to insuring a car after an accident.
“When you tell people that you can fall sick, then register and go get treated. It’s like buying a car. You don’t insure it. Then, when you knock it, you are told you can now pay for the insurance,” he illustrated.
Miskellah also highlighted moral hazard concerns, where insured individuals overuse medical services while healthcare providers inflate claims, knowing patients have coverage.
“One of the problems is that the healthcare provider knows that you have a cover. Then if they just remove a toenail, they’ll give you a very big surgical limb and claim higher. The problem that started with SHA is that we, as Kenyans, ourselves, are very, very corrupt. We have not protected SHA enough,” he explained.
Payment delays
He further noted that delays in reimbursements to private hospitals have created financial pressures, affecting salaries and operations.
“Almost 60% of Kenyans go to private hospitals. These guys are in business. When you don’t pay them and delay their claims, our members in the union go without salaries. Hospitals are getting closed,” he said.
Miskellah also called for strategies to redirect patients back to public hospitals, where operational costs are less of a concern and service continuity is more manageable.
“The whole idea when they were forming SHA, some people went and borrowed the Thailand model, which is perfect. But what they forgot is that 80% of Thais go to public hospitals, where workers are paid by the exchequer. Here in Kenya, the reliance on private hospitals is a huge challenge,” he added.
He stressed that while SHA works for inpatient care, outpatient services remain inadequately covered, leaving many patients paying out of pocket.
“If you go to a hospital outpatient and you pay cash when you have been told that it is free, to you it’s not working. When you go and you’re admitted and Shah pays your inpatient admission and it’s served, to you it’s working,” he explained.