Private hospitals suspend SHA services over Sh10bn pending bills

Social Health Authority (SHA) Headquarters Nairobi. [Benard Orwongo,Standard] Private hospitals across Kenya have suspended services under the Social Health Authority (SHA), citing ballooning pending bills and delayed claim settlements that have left facilities financially strained. In a statement issued on Monday, the Rural and Urban Private Hospitals Association of Kenya (RUPHA) said the decision, effective Monday, September 22, was "painful but necessary" after SHA failed to address issues raised in a two-week ultimatum "RUPHA has today taken the painful but necessary decision to suspend the provision of healthcare services on credit to the Social Health Authority (SHA). Effective today, all healthcare services (unless otherwise stated) for SHA beneficiaries will be provided on a cash basis," said Dr Brian Lishenga, the association's chairman. RUPHA represents more than 700 private and faith-based hospitals nationwide. According to the association, SHA owes hospitals Sh10 billion in unsettled claims, part of a larger Sh76 billion backlog that has crippled healthcare facilities. Dr Lishenga said the crisis was worsened by a Cabinet directive on August 27, when Health CS Aden Duale ordered the rejection of claims worth Sh10.6 billion. He noted that this decision violated contract provisions requiring SHA to provide written reasons for rejection within 14 days, giving providers a chance to respond. "Our notice outlined specific concerns that had to be addressed for providers to continue extending credit to SHA. Unfortunately, none of these issues have been resolved, leaving hospitals in a state of financial paralysis and putting our patients at risk," he said. Other grievances include discrimination in claims settlement, with hospitals accusing SHA of abandoning automated "first-in, first-out" processing for human adjudication, which they say has created "winners and losers" in reimbursements. The association further highlighted unsettled historical debts dating back to 2017, despite a presidential directive in March 2025 that all verified claims below Sh10 million be paid immediately. "There are no 'NHIF debts' and 'SHA debts' all liabilities are legally owed by SHA," Lishenga added. To reinstate credit services, RUPHA has demanded immediate payment of all claims under Sh10 million, verification of higher claims within seven days, reversal of the mass rejections, and creation of an independent dispute resolution tribunal. It also called for reforms in SHA's financing model to reduce overreliance on salaried workers and sustainably bring in the informal sector. On Sunday, RUPHA said the action was necessary to keep hospitals open, maintain essential supplies, and ensure staff salaries are paid. "We regret the inconvenience this may cause and assure you that this action is driven by our commitment to serve patients with dignity and care," the notice read. SHA took over from the National Health Insurance Fund (NHIF) in October 2024, but providers say delays in claim settlement have only worsened. "We wish to make it clear that we will not extend any further credit to the Social Health Authority (SHA). The reason is simple: SHA has already proven to be a bad borrower and a bad debtor. When one realizes they are being deceived, it becomes necessary to draw the line," he stated. Dr Lishenga revealed that hospitals have extended credit worth Sh76 billion to SHA, yet instead of honoring its obligations, the Authority has subjected healthcare providers to ridicule, with the Ministry branding hospitals as cartels and fraudsters. This is the only "reward" we have received for supporting the Authority in delivering its mandate. "We will continue to offer emergency and critical services, but we cannot and will not continue extending credit to an institution that has repeatedly demonstrated ingratitude and an inability to meet its obligations."

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