The Aga Khan University Hospital is concerned about continued delays in payments from the defunct National Health Insurance Fund (NHIF), warning that outstanding claims totalling Sh1.5 billion could soon jeopardise its critical services, including medical training and research.
Rashid Khalani, the hospital’s chief executive officer (CEO), said these unpaid bills - which have been accumulating since 2018 at its facilities in Nairobi, Mombasa and Kisumu - have disrupted financial planning and hampered investment in technology and infrastructure.
“These delays are affecting our financial planning, slowing expansion, and jeopardising our investments in technology, research and medical training,” Mr Khalani said.
While the hospital has maintained its clinical standards through robust internal quality controls, he warned that the current situation is not sustainable.
“Everything has a cost - staff, equipment, drugs and laboratory work. If these costs are not paid, quality will eventually suffer. At the moment we are still absorbing the shocks, but this is not sustainable in the long term.
Compounding the financial burden is Kenya’s ongoing transition from NHIF to the new Social Health Insurance Fund (SHIF). Although the SHIF aims to expand access to private healthcare, it has also put additional pressure on providers like the Aga Khan.
“Even before SHIF, about 20 to 25 percent of our patients paid cash. The perception that Aga Khan only serves insured patients is wrong,” said Mr Khalani. “SHIF has opened more doors for Kenyans to access private healthcare. However, as more SHIF patients come and payments are not made on time, it creates a strain and reduces capacity.”
In response to growing concerns from health facilities, the government has established a 19-member NHIF pending medical claims verification committee.
The committee has been tasked with reviewing claims submitted between July 1, 2022, and September 30, 2024, verifying their authenticity and recommending reforms.
Health Cabinet Secretary Aden Duale noted that claims under Sh10 million will be settled immediately, while larger claims will undergo a comprehensive 90-day verification process.
“After verification, a payment plan will be agreed for all genuine claims,” he said.
Mr Duale stressed that the initiative was aimed at restoring confidence in the health financing system and aligning resources with the government’s Universal Health Coverage (UHC) targets.
“If left unaddressed, the effects of delayed payments can ultimately affect clinical outcomes. As hospitals struggle to meet operating costs, pay suppliers, retain staff, and invest in innovations that support quality care,” warned Mr Khalani.
