Private hospitals warn of closure by December over unpaid NHIF, SHA debts
By Faith Lagat, September 8, 2025Brian Lishenga, chairperson of the Rural and Urban Private Hospitals Association of Kenya (RUPHA), has issued a stark warning that the sector’s sustainability is at risk unless the government addresses the outstanding liabilities immediately.
Speaking during an interview with a local TV station, on September 8, 2025, Lishenga elaborated on the gravity of the situation, stating, “We have Ksh 76B in debt as a sector, Ksh 33B NHIF debt and Ksh 43B SHA liability, now the health sector cannot continue bearing this burden.”
He further warned, “What we are saying is this: if this Ksh 33B debt is not paid immediately, we are trying to tell the Kenyan people that it is very likely that by December, either you will not have private hospitals, these private hospitals where 80 percent of lower people go, either you will not have them or the entire system will revert to 100 percent cash.”
He noted that the financial stability of Kenya’s healthcare sector is under severe threat as private hospitals face a potential collapse due to unpaid debts from the National Hospital Insurance Fund (NHIF) and the Social Health Authority (SHA).
With a total debt of Ksh 76 billion, comprising Ksh 33 billion from NHIF and Ksh 43 billion from SHA, the burden on private hospitals is unsustainable.
This crisis could lead to a scenario where private hospitals, which serve 80 percent of lower-income Kenyans, either cease operations or revert to a cash-only system by December 2025, severely impacting access to healthcare.
The fear of SHA’s collapse is growing. “The reason why we are giving this notice is not because, as I said, we like SHA, but in fact, we are giving this notice because we are scared that SHA will collapse. If this is not sorted and all hospitals, at least the ones on the private and faith-based, start asking Kenyans to pay out of pocket, you will have a vicious circle,” he cautioned.
Government debt burden
Lishenga emphasized the urgency, stating, “It is imperative for the president to pay the debt that was outstanding to be actioned immediately.”
He also highlighted the disproportionate burden on government hospitals. “We have gone further and said, even this issue of verification of NHIF debt, 10 percent of the NHIF debt is owned by 2 hospitals, MTRH and KNH, government hospitals, so when people are saying we will not pay thugs, we will not pay thieves, you are lumping the two hospitals. And in fact, those two owe the most debt,” he said.
“These hospitals own Ksh 15.2 billion, half of the NHIF debt. So let the president maintain his promise. The health sector, I mean, I have sympathy for road contractors. I have sympathy for them, but road contractors, maybe life at stake, but the health system needs money for it to function,” he added.
Funding model flaws
The financial strain extends beyond debt repayment, with SHA’s funding model under sharp scrutiny. According to Dr. Lishenga, salaried Kenyans, who constitute less than 10 percent of the population, are shouldering 96 percent of the financial burden.
“SHA has been unable to raise enough money because it is relying heavily on the employed, so guys with the salary carry the burden of 96 percent of the SHA contribution yet, they only represent less than 10 percent of Kenya’s population, this is the major problem at the core of our financial issues,” he explained.
The informal sector, despite comprising over 80 percent of the workforce, contributes minimally, with only Ksh 600,000 monthly compared to Ksh 5.4 billion from 3.4 million salaried workers. This disparity, coupled with unpaid claims totalling Ksh 96.2 billion, with only Ksh 53 billion settled, has forced RUPHA to issue a 14-day ultimatum for the government to act.