Private Hospitals Suspend Services for SHA Beneficiaries Over Ksh 76 Billion Debt
Kenya’s healthcare system was thrown into crisis today after the Rural & Urban Private Hospitals Association of Kenya (RUPHA) announced the immediate suspension of credit facilities to the Social Health Authority (SHA). The decision means that patients covered under the government’s new social health scheme must now pay for services at private hospitals on a cash basis.
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RUPHA, representing private and faith-based health facilities nationwide, stated in a press statement that the move was necessary to prevent the "collapse" of hospitals burdened by massive unpaid claims and what they termed as “deliberate” financial paralysis by the SHA.
Hospitals “Collapsing Under the Weight” of Debt
Dr. Brian Lishenga, Chairman of RUPHA, signed the statement which laid out the dire financial situation. The association cites an overwhelming Ksh 76 Billion in total debt owed to its hospitals.
The debt is comprised of three main components:
1. Mass Rejection of Claims: An immediate Ksh 10.6 Billion in valid claims have been mass-rejected by SHA, which RUPHA says was done without following the provider contract, denying hospitals the right to clarify or remedy the claims.
2. Legacy Debt Crisis: SHA currently owes private facilities Ksh 43 Billion, with an additional Ksh 24 Billion in claims stuck "in review," leading to a Ksh 67 Billion debt crisis under the new authority.
3. Unpaid Historical Liabilities: Hospitals are still owed claims dating back to 2017, which President William Ruto had directed be settled in March, but no payments have been made on claims exceeding Ksh 10 million.
The association warned that the current financing model—where a few salaried workers contribute almost everything while 88% of the workforce contributes almost nothing—is unsustainable. "If the private and faith-based sector falls, half of Kenya’s healthcare system fails — and patients will pay the price in cash, suffering, and lives," the statement read.
RUPHA’s Key Demands to Avert Collapse
The suspension of credit facilities follows the expiry of a two-week notice issued to the SHA on September 5th. RUPHA has put forward five non-negotiable demands that must be addressed to restore services:
•Immediate Settlement of Verified Claims: Settle all verified claims worth Kshs 10M and below.
•Fast-Track Verification: Implement a fast-tracked verification and payment system for larger claims (above Kshs 10M) within 7 days.
•Independent Dispute Resolution: Ensure immediate reversal of mass claim rejections and establish an Independent Dispute Resolution Tribunal.
Urgent Financial Reform: Implement urgent reform of the SHA’s financing model.
Review and Reversal: Review and reverse all arbitrary downgrades and bed deletions that have wiped out nearly 3,500 maternity beds, 1,000 delivery beds, and over 10,000 inpatient beds, particularly affecting rural and poor urban areas.
Teachers and Police Schemes Under Threat
RUPHA also raised alarm over the planned "unfunded migration" of the Teachers' and Police medical schemes to the SHA in December, following the expiry of their current Minet/MAKL-led insurance.
The association warned that this migration must not proceed without firm guarantees and the clearance of all outstanding arrears owed by Minet and the defunct NHIF to private hospitals. RUPHA stated that this transition, without addressing the current arrears, "will only worsen the crisis."
RUPHA concluded its statement by calling on the government to build its partnership with the private sector on "fairness, sustainability, and respect for the law," emphasizing that “The time to act is now.”
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