The Rural & Urban Private Hospitals Association of Kenya (RUPHA) has issued new directives requiring hospitals to continue offering emergency medical care despite the planned suspension of Social Health Authority (SHA) services starting Monday, February 24. The directive seeks to prevent disruptions in critical care while addressing the financial strain caused by unpaid claims from the SHA and Medical Administrators Kenya Limited (MAKL).
RUPHA has instructed hospitals to honor all inpatient admissions and scheduled outpatient visits booked before February 24. However, new admissions under SHA or MAKL will only proceed if the insurer guarantees upfront payment. This decision follows persistent delays in settling hospital claims, prompting private healthcare providers to halt SHA-funded services.
To ensure minimal disruption to patients, hospitals have been directed to stabilize all emergency cases before referring them to facilities that still accept SHA or MAKL coverage. “Emergency cases shall not be denied care under any circumstances,” RUPHA stated in a communiqué on Sunday. Once stabilized, patients relying solely on SHA or MAKL coverage will be referred to other hospitals willing to provide treatment under the scheme.
Hospitals have been advised to communicate changes professionally at the point of care rather than through public notices or social media. Front desk personnel are required to inform patients about the temporary unavailability of SHA and MAKL services and offer alternative payment arrangements. In cases where SHA or MAKL coverage is not an option, patients will be guided on self-payment plans or referred to alternative healthcare facilities.
Furthermore, hospitals must maintain comprehensive documentation of all cases where service provision is impacted by SHA or MAKL funding constraints. The association has warned healthcare facilities against engaging in direct confrontations with government agencies and has advised them to escalate unresolved disputes through RUPHA for legal or arbitration-based resolution.
RUPHA Chairperson Brian Lishenga has accused the government of neglecting its financial obligations, leaving hospitals in financial distress. According to Lishenga, many healthcare providers have struggled with unpaid claims dating as far back as 2017. He criticized the government’s approach to resolving the crisis, noting that SHA contributions from Kenyans are being used to cover NHIF deficits instead of directly funding hospital reimbursements.
“I was speaking to some insiders. They told me they spoke with the president, who categorically said there is no money,” Lishenga revealed. “SHA authorities have been shut down consistently and told there is no money. The fallback was to register as many people as possible, hoping there would be an SHA windfall that would cover NHIF deficits.”
The ongoing financial crisis has left hospitals struggling to manage operations, with many unable to sustain SHA-funded services. RUPHA reaffirmed its commitment to pursuing outstanding payments through legal channels and arbitration while urging hospitals to report any external pressure to continue SHA or MAKL-funded services without financial guarantees.
The association stressed that the suspension of SHA services is a necessary measure to safeguard healthcare providers from financial ruin while ensuring that patients, especially those in emergency situations, continue to receive the medical attention they need.
As the suspension date approaches, healthcare stakeholders are calling on the government to resolve outstanding arrears and implement sustainable funding strategies to prevent further disruptions in service delivery.
