The Kenyan government has reiterated its dedication to ensuring free primary healthcare services in all public health facilities nationwide while addressing concerns over pending claims under the now-defunct National Health Insurance Fund (NHIF).
In a statement, the Social Health Authority (SHA) assured Kenyans that registered members can access primary healthcare services at government facilities without restrictions. The authority emphasized that healthcare accessibility remains a top priority, having contracted 8,600 healthcare providers across the country. A full list of these facilities is available on the SHA website and at Huduma Centers.
SHA has also made significant progress in disbursing payments to healthcare providers. This week alone, the authority released Ksh5.1 billion, bringing the total payouts since October 2024 to Ksh18.29 billion. Additionally, primary healthcare facilities have received Ksh1.3 billion under a new capitation model, with 51% of these funds allocated to private healthcare providers.
Addressing concerns about outstanding NHIF claims, SHA confirmed that Ksh10 billion out of Ksh19 billion in undisputed claims has already been settled. The authority is collaborating with healthcare providers to reconcile pending NHIF claims, with 60% of the reconciliation process already complete. SHA has urged healthcare facilities to provide proof of archived claims to facilitate verification and expedite payments.
To enhance efficiency in claims processing, SHA has announced a nationwide training initiative on the Primary Healthcare (PHC) reimbursement model, set to begin on February 27, 2025. Healthcare providers are encouraged to submit their financial returns promptly to ensure timely payments and improve service delivery.
Furthermore, SHA has refuted claims that the government owes private facilities Ksh30 billion. In particular, the authority dismissed reports from the Rural Private Hospitals Association of Kenya (RUPHA) that suggested such a debt existed. SHA reassured that RUPHA facilities are being trained on claim management to improve the accuracy of submissions and reduce delays. These facilities now have access to an online dashboard, enabling them to track their payments more efficiently.
The government remains committed to ensuring that Kenyans continue to receive quality healthcare without financial barriers. By addressing NHIF-related challenges and improving claim processing mechanisms, SHA aims to strengthen trust between healthcare providers and the state, ensuring the sustainability of the country’s healthcare system.
