Private and faith-based hospitals across Kenya are pressing pause on services under the Social Health Authority (SHA). The decision, announced by the Rural & Urban Private Hospitals Association of Kenya (RUPHA), comes after months of delayed reimbursements. Some facilities have now been told to serve SHA-covered patients on a cash basis until payments resume, a move that immediately affects thousands of households relying on the state cover.
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| Social Health Authority, CC BY 4.0, via Wikimedia Commons |
What’s driving the suspension?
RUPHA says persistent payment delays and unpaid claims have pushed hospitals to the brink. Today’s developments follow fresh reports that private hospitals are halting SHA services over significant pending bills—figures cited by outlets vary, but current reporting places the latest tally around the billions-of-shillings mark.
For wider context, industry estimates in recent weeks and months have painted a much bigger picture: private providers have flagged a sweeping backlog of claims dating back to the transition from NHIF to SHA, with sector leaders previously warning of tens of billions outstanding. One detailed report last month put the combined pressure at Sh76 billion in unpaid claims tied to SHA and legacy liabilities, showing just how deep the hole has become.
What this means for patients
If you walk into a private hospital with an SHA cover today, you may be asked to pay cash. That’s the immediate impact. Some facilities may choose to refer patients to public hospitals or alternative centers if a cash option isn’t possible. The goal, providers say, is to keep care running safely without taking on more debt they can’t cover.
- Outpatient visits: Expect requests for cash while SHA reimbursements are delayed.
- Elective procedures: Many will be deferred unless patients can self-pay or use a different cover.
- Emergency care: In earlier suspensions, RUPHA advised members to stabilize emergencies before making referrals—a pattern that may guide today’s response as well.
Why are payments delayed?
Hospitals cite a mix of slow claim verification, system bottlenecks, and budget constraints during the shift from NHIF to SHA. Over the past year, provider surveys and public briefings have flagged glitches on the claims portal, lengthy reconciliation, and uncertainty over how fast arrears would be cleared. While today’s halt is immediate, the roots of the problem have been building for months.
The bigger picture
This isn’t the first confrontation between private hospitals and the government over reimbursements. In February, RUPHA suspended SHA services, then briefly restored them after assurances on clearing smaller NHIF-era claims; still, arrears and new SHA bills continued to pile up, keeping hospitals on edge. Today’s stop underscores how fragile the financing chain remains.
What experts are saying
Health financing analysts warn that when reimbursements lag, facilities dip into overdrafts, delay staff salaries, and ration supplies—issues that can quickly snowball into service disruptions. RUPHA leaders have repeatedly argued that private hospitals can’t “subsidize a broken system” without timely repayment, framing the cash-basis shift as a last-resort step to protect patient safety and keep doors open.
Is there a path out? Yes—but it’s narrow. Experts say clearing a portion of arrears fast (especially older, verified claims), publishing a transparent payment schedule, and stabilizing the claims system could unlock confidence. Without that, more facilities may limit services—or exit the scheme entirely.
What should patients do in the meantime?
- Call ahead: Confirm whether your hospital is accepting SHA or requires cash.
- Ask about referrals: If a service isn’t available on credit, request a referral to a public facility or another provider.
- Keep receipts and documents: If you pay out of pocket, retain paperwork in case reimbursements resume.
What RUPHA and hospitals want
The association’s demands have been consistent: clear verified arrears, streamline the reimbursement model, and fix claim-processing systems so hospitals can plan, stock up, and pay staff on time. Today’s step—stopping SHA services in private hospitals—appears designed to force a rapid fix by making the pain of delays visible at the point of care.
What to watch next
Will the government announce a fresh payment schedule? Will partial settlements restart services quickly? And can SHA’s claims platform be stabilized to stop new backlogs from forming? Those answers will determine how long this cash-first reality lasts—and how confident hospitals feel about staying in the scheme. For now, Kenyans should prepare for short-term disruptions while hoping for a swift, credible plan to pay down the debt and reboot trust.
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