Private hospitals have resumed Social Health Authority (SHA) services a day after President William Ruto directed partial payment of debt owed by government to the facilities.
The Rural and Urban Private Hospitals Association of Kenya (Rupha) lifted the suspension of SHA services in its member facilities, allowing patients to once again access care under the scheme.
This comes a day after the President announced a payment plan to settle Sh33 billion debt his administration inherited from the defunct National Health Insurance Fund (NHIF).
The President assured hospitals that all their claims will be paid, except for those that are about Sh10 million which will have to wait longer as they need verification.
“The government is fully committed to providing Universal Health Coverage to every Kenyan without discrimination. I would like to assure all Kenyans that any challenge being experienced in the implementation of Taifa Care is being attended to and resolved,” said President Ruto.
Rupha says the decision to lift the suspension is in the best interest of patients following the government’s response. They also ask Parliament to expedite the approval of the supplementary budget that is needed to implement the pending claims.
“While we acknowledge the need for verifying claims above Sh10 million, we urge the government to disburse at least Sh10 million upfront to these facilities. We will continue to monitor the implementation of these commitments,” said Dr Brian Lishenga, Rupha chairperson.
“Should there be delays in disbursement, lack of transparency in the verification process, or failure to uphold agreed timelines, Rupha will not hesitate to reconvene its members and take necessary action, including reinstating service suspensions,” he added.
Even though Rupha has agreed to lift the ban on SHA, Dr Lishenga said the government should pay the verified facilities (about 500 of them) in the next seven days.
Rupha has not backed down on the suspension of teachers’ and police insurance providers –Medical Administrator Kenya Limited (MAKL).
“The suspension will continue indefinitely due to MAKL’s failure to engage with providers and address the serious concerns affecting service delivery,” said Dr Lishenga.
Rupha leaders say that MAKL has not conducted any outstanding hospital claims, leaving providers uncertain in regards to what they are owed.
“MAKL does not issue remittance advice for payments made, meaning hospitals have no visibility on what is being paid and why,” said Joseph Kariuki, vice chairperson of Rupha.
“MAKL continues to impose arbitrary invoice deductions of 10 to 30 per cent without the provider’s consent. Rupha calls for immediate intervention of Minet and CIC, the underwriters of the MAKL scheme, to restore financial fairness to healthcare providers,” he added.
Separately, Faith-based healthcare providers have issued a 14-day ultimatum to the government to settle the Sh10 billion debt owed to them or require patients to pay cash for services at their facilities.
The government’s outstanding debt to these facilities includes Sh6.8 billion in National Health Insurance Fund (NHIF) arrears, Sh2.2 billion in unpaid Social Health Authority (SHA) claims, and Sh1 billion under the Medical Administrator Kenya Limited (MAKL) which has remained unpaid since July last year.
Healthcare providers warn that if the funds are not released, thousands of patients, many of whom rely on subsidised healthcare at faith-based hospitals, will be forced to pay out of pocket, further deepening the country’s healthcare crisis.
“We (faith-based leaders) have reached a painful decision, since we cannot afford to take in more debt after numerous engagements with the Ministry of Health, SHA and some Government leaders,” said the leaders in a joint statement.
“Majority of our hospitals are owed claims exceeding Sh10million and this means we are the lot that will have to wait for three months for the verification committee to be constituted. While waiting, we are financially constrained,” says a statement.
The service providers now say that they have reached their saturation point and are experiencing an unprecedented crisis.
In a joint statement to the media, their consortium leaders lament that the government is not listening to them and Kenyans who will visit their facilities around the country will be forced to pay out-of-pocket if the government fails to resolve their issues in the next 14 days.
On Wednesday evening, President William Ruto said that the government would pay all historical claims starting with those that are below Sh10 million –comprising about 91 per cent of the facilities.
On the other hand, about 9 per cent of the facilities whose claims are above 10 million will have at least 90 days of waiting until a committee is set up to verify their claims.
Faith-based healthcare providers say they cannot wait that long as the existing debts have already paralysed their service provision.
“This is grossly inadequate to relief the cash flow distress among the faith-based hospitals. The ones left unpaid handle the more complicated diseases, specialised surgeries and critical patients which are costly and lifesaving,” they said in a statement.
The leaders said that most of their organisations fall under the 9 percent facilities whose claims will need verification from a committee but they cannot wait for 90 days.
Since the rollout of SHA in October last year, only half of the claims raised by faith-based facilities have been paid.
They now demand payment of all SHA pending claims by March 21, 2025. They say that their pending claims have exceeded the 90 days of payment as is in the Social Health Insurance Act 2023.
Historical NHIF debts, delayed Social Health Authority payment claims as well as teachers’ and police’s insurance debts under the Medical Administrator Kenya Limited (MAKL) have plagued the ambitious effort to have all Kenyans access affordable healthcare.
Reverend Dr Robert Lang’at, Chairman of the Board at AGC Tenwek Hospital told the press that while faith-based facilities are offering about half of health provision in the country, it is the first time that they have had a crisis of such magnitude and that their services risk facing imminent closure.
“The church is not at war with the government. Does anyone in government have any doubt on the veracity of the claims of the faith-based facilities? If so, why has it taken months? Why is our system so bureaucratic?” he asked.
Bishop Norman Wambua, vice chair of the Kenya Catholic Conference of Bishops (KCCB) said that it is painful that the very people they (religious leaders) defend, have to make an unfortunate decision to turn them away when they visit their facilities.
“It is like a mother abandoning a child. We are not able to absorb any more debts,” he said.
“Creditors are at our doors asking for money, our workers are there and it has become a painful experience. The government is not willing to pay us for whatever reasons. If the government has no money, let them tell us, let them call a spade a spade and ask Kenyans to pay out of their pockets,” added Bishop Wambua.
The facilities also ask the government, through SHA, to reduce claims processing stages. At the moment, there are about 10 stages that they have to go through to get their claims which delays seamless service provision.
They also say that hospitals are not able to get help from SHA regional offices.
“They seem not to have been trained or empowered to make any decisions. They always refer all questions and support requests to the system developer who appears to be outside of SHA, unreachable and with all authority,” said their joint statement.
They say that SHA also needs to provide a transparent dashboard for invoice tracking that can be downloaded for review by hospitals.
The consortium leaders ask parliament to make adequate provision for the Primary Health Care and Emergency, Critical and Chronic Illness Funds.
“Primary Healthcare is virtually collapsed in levels 2-3 and some level 4 facilities that opted to offer services due to lack of capitation funds. The Quarter of January to March 2025 has not been paid to date while capitation is expected to be paid up front,” they said in a statement.
