SHA crisis: Authority and hospitals fail to agree

Rupha controls 500 striking hospitals. SHA says Kenyans have about 8,000 facilities to choose from.

by JOHN MUCHANGI

Health25 February 2025 - 23:46

In Summary

The most significant barriers include prolonged system downtime, delays in One-Time Password (OTP) verification, and an inability to track claim approvals—issues that have worsened over the past month, Rupha says.

The Social Health Authority (SHA) has laid blame for unpaid claims at the door of the striking private hospitals.

SHA acting CEO Robert Ingasira said the authority does not owe members of the Rural-Urban and Private Hospitals Association (Rupha) the Sh30 billion they are demanding. He did not say how much SHA owes them.

He also suggested that many of those facilities had submitted inaccurate claims for reimbursement, because they are not well conversant with the authority’s claims system.

“We wish to clarify that the government does not owe Rupha Sh30 billion, as asserted. Rupha facilities will receive training on claim management to improve the accuracy of claim submissions and prevent delays,” he told journalists in an evening press briefing on Tuesday.

Kenyans pay 2.7 per cent of their incomes to SHA, which has contracted health facilities to offer treatment on credit. The facilities later claim these costs from SHA, which should pay within 90 days.

However, Rupha members stopped offering services to SHA members on credit on Monday. Insured patients now have to pay in cash.

The association consists of about 500 privately-owned health facilities from Level 2 to level 5.

Ingasira said SHA members have about 8,600 facilities to choose from.

“The list of contracted healthcare providers is available on the SHA website, and members can also access this information at SHA branches and Huduma Centers nationwide,” he said.

This means the dispute between SHA and its Rupha services providers continues.

Ingasira said the authority and the hospitals representatives met on Monday, but they did not resolve the impasse.

Last week, Rupha chairperson Dr Brian Lishenga said that challenges surrounding the new healthcare system have been ignored, endangering the lives of patients.

The most significant barriers include prolonged system downtime, delays in One-Time Password (OTP) verification, and an inability to track claim approvals—issues that have worsened over the past month, he said.

Lishenga said the association is demanding that the government settle about Sh30 billion NHIF arrears in full.

"We have unpaid debt dating back to 2017, hospitals are facing bank defaults, we have stock out of essential medicines and many consultants haven't been paid for years," he said.

“The relevant authorities have ignored the challenges facing this new healthcare system, putting patients’ lives at risk and threatening the survival of hospitals due to weak service provision.”

In response, Ingasira said only less than Sh9 billion in undisputed NHIF claims are unpaid.

“The government remains committed to honoring undisputed NHIF claims. As of October 4, 2024, Sh10 billion out of Sh19 billion in undisputed NHIF claims has already been paid,” he said.

“SHA is working with healthcare providers to finalize NHIF pending claim reconciliations, which are currently 60 per cent complete. Healthcare facilities must provide proof of archived claims to facilitate verification before payments are processed.”

Rupha is also calling for a revision and streamlining of the SHA outpatient reimbursement model to ensure that facilities are adequately compensated.

Additionally, Rupha wants the government to guarantee fair and timely payments under Medical Administrators Kenya Limited, which manages medical schemes for police officers and teachers.

Lishenga noted that 54 per cent of hospitals have not received payments from SHA, while 89 per cent of facilities have reported failures in the SHA portal.

He further stated that 83 per cent of hospitals struggle to verify patient eligibility due to frequent system glitches.