Private hospitals threaten to stop services should the SHA fail to pay the Sh43B debt

The Rural Urban Private Hospitals Association (RUPHA) of Kenya leadership, Dr. Brian Lishenga (Chairman-l) and Vice Chairman, Rev Joseph Kariuki (r) during a press conference in the Association's offices off Lunga Lunga Road in Industrial Area, where they called out Health Cabinet Secretary, Aden Duale accusing him of politicizing the war against graft in the health sector in the country.[Benard Orwongo, Standard]

Kenyans are at risk of being denied access to healthcare should the government fail to pay debts owed to hospital facilities under the Rural and Urban Private Hospitals Association of Kenya (RUPHA) within the next two weeks. 

This after the lobby group issued a 14-day go-slow notice, threatening to stop providing services to patients, citing delay in payment of claims that they say has put the facilities in "severe financial distress."

According to Rupha, the Social Health Authority (SHA) and the defunct National Hospital Insurance Fund (NHIF) cumulatively owe Sh76 billion to the hospitals.

Speaking on Friday during a press briefing at the association's offices in Nairobi, Rupha chairperson Dr. Benard Lishenga demanded immediate settlement of NHIF liabilities in line with the Presidential Directive of March 5, 2025.

"Hospitals are in crisis, he decried, noting that SHA alone is yet to pay Sh43 billion owed to their members. "Patients are having difficulties in many hospitals; unless something happens, we are staring at a lot of hospitals shutting down, and patients will struggle to get healthcare."

He added: "50 per cent of all claims from lower-level facilities (Levels 2-4) remain unpaid. In particular, general inpatient and surgical claims have stagnated, with hospitals reporting 10 to 20 payout ratios in these categories."

The debts owed to hospitals through the SHA have recently been a matter of public debate, with the Auditor General's report of fraud on the entity fuelling outrage.

Dr. Lishenga tore into the inconsistencies with the system, accusing government officials of politicising fraud within SHA.

"We demand to know the names of the facilities and publish the amount owed," he said, faulting the government over what they termed as a blanket rejection of claims.

He lamented over lack of a system that allows for the submission of clarification documents and a dispute resolution tribunal to handle complaints.

"SHA has arbitrarily deleted bed capacities, downgraded, and suspended facilities without following due process. This undermines the Fair Administrative Action Act and the Constitution of Kenya. Such actions weaken service delivery in rural and urban Kenya alike," he said.

Rupha now want a clarification mechanism in the SHA portal to enable facilities to resubmit valid but rejected claims, as well as the constitution of the dispute resolution tribunal to oversee suspensions, downgrades, and investigations into facilities.

"We demand transparent publication of claims data showing not only amounts paid, but also total submitted, approved and payout ratios," he stated, warning that, unless the outstanding claims are paid, hospitals will not be able to run by December.

He appealed to President William Ruto to relook at the model of SHA, saying the majority of subscribers do not contribute after registering.

"We cannot put the burden of an entire nation on 3.5 million people who earn salaries," he said.