The crisis in private health facilities is expected to worsen after the more than 300 facilities operating under the Kenya Association of Private Hospitals (KAPH) suspended services under the Social Health Authority due to unpaid arrears.

This came as acting SHA Chief Executive Robert Ingasira disputed the Sh30 billion being demanded by the Rural and Urban Private Hospitals Association (RUPHA) in arrears.

Instead, Ingasira said RUPHA facilities will receive training on claim management to improve the accuracy of claim submissions and prevent delays.

PHC reimbursements

“To enhance efficiency in claims processing, training on the PHC reimbursement model will be conducted for all facilities starting Thursday, February 27, 2025,” Ingasira told journalists.

According to Ingasira, this week, SHA has disbursed Sh5.1 billion towards Social Health Insurance Fund (SHIF) claims, bringing the total amount paid since the rollout in October 2024 to Sh18.29b.

“This does not include claims currently undergoing clinical review and reconciliation,” he said.

He asked facilities that have signed contracts and received SHA payments to continue providing services while the NHIF debt resolution process is ongoing.

Since its rollout, Ingasira said, SHA has disbursed Sh1.3b to primary healthcare facilities, with 51 per cent allocated to private providers. Payments are processed fairly and promptly upon claim verification.

“In the first quarter, NHIF data was used for payments. Going forward, payments will be based on actual data from new SHA registrations,:e he disclosed.

He said SHA is currently compiling returns from healthcare providers to facilitate the release of funds for the second quarter, with payments expected by the end of the month.

To ensure an efficient payment process, healthcare providers are urged to submit their Quarter 2 returns for FY 2024/2025 promptly. Timely submissions enable clinical reviews, reconciliation, and fund disbursement.

Forcing patients

Hospitals under RUPHA suspended their engagement with SHA on Monday and have since been forcing patients visiting the facilities to either pay out of pocket or return home without treatment.

The situation is now likely to worsen with the announcement of KAPH joining the bandwagon to disengage SHA due to unresolved inefficiencies in the defunct National Hospital Insurance Fund (NHIF)-SHA transition, an unclear operational and reimbursement framework for outpatient services, outstanding NHIF arrears amounting to Sh 30 billion and long standing unpaid claims under the Medical Administrator Kenya (MAK).

“During a Special General Meeting (SGM) held on February 24, 2025, KAPH members unanimously resolved to indefinitely suspend all credit arrangements under SHA insurance scheme and MAK Limited effective immediately,” a statement signed by KAPH chairman Dr Erick Musyima stated.

The association said the sustainability of private hospitals and the health and well being of millions of Kenyans depends on immediate action.

He said private hospitals provide critical healthcare services to over 52 percent of the population, therefore, without urgent intervention, their ability to deliver essential care is now in jeopardy.

“The ongoing financial strain on hospitals has already triggered mass job losses in the healthcare sector, delays in salary payments for medical professionals and staff, severe shortages of essential medical supplies, loan defaults and financial distress among private facilities,” Dr Musyima added,

The association said the decision was made in response to persistent financial instability that has placed the quality, accessibility, and sustainability of healthcare services at grave risk.

“This is not a decision we have taken lightly. It follows months of unsuccessful negotiations with government authorities and MAKL, repeated unfulfilled promises, and an increasing financial burden that is now threatening the very survival of private healthcare facilities across Kenya,” Dr Musyima said .

Dr Musyima said the current crisis in the health sector does not just impact on hospitals, but it undermines the national healthcare system and threatens Kenya’s commitment to achieving Sustainable Development Goal (SDG) 3.8 on Universal Health Coverage – UHC).

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