Hospitals warn of maternal deaths after SHA cuts maternity services

Dr Patrick Amoth, Director General of Health, addresess the press on 5th March 2025 at SHA Building located at Upper Hill in Nairobi. [Edward Kiplimo, Standard]

Private hospitals have written to Director General of Health Dr Patrick Amoth, urging him to advise the Ministry of Health to reinstate maternity services in lower-level facilities.

This follows the removal of maternity and inpatient bed capacity for Level 2 and 3 hospitals under the new health scheme.

The hospitals warn that the lack of maternity services at these facilities could lead to increased maternal deaths.

In Kenya, at least 21 women die every day while giving birth due to complications.

In a letter to Amoth, the Rural and Urban Private Hospitals Association of Kenya (RUPHA) noted that Social Health Authority (SHA) provider portal, administered by the Digital Health Agency (DHA), implemented changes that removed maternity and inpatient bed capacity.

The changes affected all Level 2 facilities, including those with documented maternity services, and Level 3 hospitals without theatre services.

RUPHA further claimed that the Kenya Medical Practitioners and Dentists Council (KMPDC) unlawfully reclassified the hospitals in June and July.

"We recommend that your office urgently advise Health Cabinet Secretary Aden Duale on the impact of removing maternity and inpatient bed capacity from Level 2 and 3 facilities. This affects access to essential services, worsens maternity and neonatal outcomes and increases out-of-pocket costs for poor households," reads part of the letter dated July 29, 2025.

The letter adds: "We request that you issue a technical advisory to KMPDC, DHA and SHA, clarifying the scope of services permitted at primary care facilities, particularly maternity, immunisation and inpatient services in Level 2 and 3 institutions."

According to RUPHA, the changes in the SHA portal have eliminated 1,278 beds from Level 2 facilities and 2,200 from Level 3B, amounting to a total loss of 3,478 maternity beds, an estimated 18.6 percent of the national maternity bed capacity.

"It also means that 1,080 delivery beds have been removed, about 28.6 percent of the national total," said Rupha chairman Dr Brian Lishenga.

He further noted that the reclassification, allegedly directed by Afya House and implemented by KMPDC, has resulted in the downgrading of 1,138 Level 3B inpatient facilities, leading to the loss of up to 10,000 inpatient beds.

These concerns, RUPHA says, are based on data from the 2023 Kenya Health Facility Census.

According to Dr Lishenga, the removal of maternity and inpatient services from Level 2 and 3B health facilities will hinder access to essential care, leading to poor maternal and neonatal outcomes and rising out-of-pocket costs for low-income households.

Level 2 and 3 facilities serve as the primary access points for maternity and inpatient care. With the recent changes, these hospitals are no longer compensated by SHA, forcing pregnant women to pay for deliveries out of pocket.

The letter warns that requiring cash payments will limit access to quality healthcare and contribute to increased maternal and child mortality.

According to Ministry of Health data, most deliveries in Kenya occur in dispensaries and health centres, which are classified as Level 2 and 3 facilities.

The situation is especially dire in northern Kenya counties such as Mandera, Turkana, Wajir, Garissa, and Marsabit, as well as in urban informal settlements, where these facilities are often the only maternity care option.

RUPHA has also asked Dr Amoth to advise KMPDC to activate the Kenyan Essential Package for Health (KEPH) Level 3C, ensuring that facilities offering inpatient services without theatres are not unfairly downgraded, and that their capacity is accurately reflected in licensing and contracting.

Additionally, RUPHA wants the Health Ministry to reaffirm the vital role of dispensaries and health centres in delivering maternity and immunisation services.

"We wish to highlight that the 2025/26 national budget enacted cuts to the recurrent budgets of KMPDC, the Clinical Officers Council, and the Nursing Council of Kenya," the letter states.

Private facilities stressed that Dr Amoth, as a technical expert within the Ministry of Health, is well-placed to prevent the erosion of the gains made in the health sector.