State to refund patients who paid out-of-pocket after SHA rollout

The government has promised to refund patients who paid for healthcare services out of pocket since the roll out of Social Health Authority (SHA).

This comes amid confusion and frustrations across the country as patients encounter difficulties accessing services that were previously covered under the defunct National Health Insurance Fund (NHIF).

“All patients who have paid out of pocket, reach out to us and we shall refund,” said SHA Chairman Abdi Mohamed.

Dr Mohamed blamed the challenges to the transition from NHIF to SHA, which is on its seventh day.

Under the SHA, registered beneficiaries are entitled to free primary healthcare services at level two dispensaries, level three health centers, select level four hospitals, and emergency services at all health facilities.

However, delays in contract renewals with certain private and faith-based hospitals have led to hiccups in provision of healthcare services.

“All public hospitals, from Level two to six, have been contracted and are offering services to SHA-registered beneficiaries. As of today, 1,442 private and faith-based health facilities have returned newly signed contracts and are now providing services,” said Mohamed.

The SHA Chairman was speaking in Nairobi Sunday after a consultative meeting with the representatives of private and faith-based healthcare providers.

To ensure that healthcare services remain accessible during the transition, SHA has set a deadline for the healthcare providers to return signed contracts by Tuesday.

Mohamed assured that service providers have committed to ensuring continued access to care for SHA beneficiaries during the period.

To address the issue of pending bills, the government has formed a committee chaired by the Medical Services Principal Secretary Harry Kimutai.

The committee will focus on fast-tracking the settlement of outstanding bills owed to healthcare facilities.

Kimutai acknowledged that pending bills have been a significant issue, straining the resources of service providers.

"The resources of service providers are dwindling, and they are struggling to cope with additional patients seeking care at their facilities. We are moving swiftly to clear these pending bills to support the facilities in providing uninterrupted service delivery," he said.

The Rural and Urban Private Hospital Association of Kenya Chairperson Brian Lishenga said that the settlement of pending bills is not only a sign of goodwill, but is essential for them to be able to provide services.

“I am calling upon the state agencies which owe money to the defunct NHIF. Without any further delay release those funds. We as providers are ready to cooperate, but we will cooperate when we have the money as well, because it is necessary for the provision of services,” Dr Lishenga  said.

As of October 6, 2024, a total of 12,704,548 Kenyans had enrolled for SHA, including verified members transitioned from the former NHIF system under Legal Notice No. 147 of 2024.