Hospitals under the Rural & Urban Private Hospitals Association of Kenya (RUPHA) are set to suspend medical services under the Social Health Authority (SHA) starting Monday. This decision will affect thousands of teachers, police officers, and other patients relying on the government-backed health insurance scheme. The move comes as hospitals continue to grapple with unpaid bills, system failures, and operational challenges that have pushed many healthcare facilities to the brink of financial collapse.
RUPHA Chairperson Dr. Brian Lishenga raised concerns on Thursday, highlighting that challenges surrounding SHA have been persistently ignored by the government. He warned that the ongoing crisis not only endangers patients but also threatens the survival of private healthcare providers, many of which are struggling to stay afloat.
According to Dr. Lishenga, only 54% of hospitals have received payments from SHA, despite numerous claims being submitted. Additionally, 89% of hospitals have reported frequent system failures, making it difficult to process claims efficiently. Another 83% have faced challenges in verifying patient eligibility due to glitches in the online portal, further complicating service delivery.
“We have unpaid debts dating back to 2017, hospitals are facing bank defaults, essential medicines are out of stock, and many consultants have not been paid for years,” Dr. Lishenga lamented.
RUPHA’s frustration has been exacerbated by the lack of clear communication and action from the government. With mounting debts and a broken reimbursement system, hospitals under the association say they have no choice but to suspend services to SHA patients until their grievances are addressed.
RUPHA Deputy Chairperson Joseph Kariuki confirmed that private hospitals will cease offering services under Medical Administrators Kenya Limited (MAKL), the body responsible for managing insurance claims for teachers and police officers.
“We will stop providing medical services to police officers and teachers using government insurance from Monday. No services will be available for them until the government meets our demands,” Kariuki stated firmly.
The association is demanding that the government settle Sh30 billion in pending arrears from the defunct National Health Insurance Fund (NHIF), review SHA’s outpatient reimbursement model, and ensure that MAKL processes payments fairly and in a timely manner.
Launched in October last year, the SHA was meant to replace the NHIF and improve healthcare access for millions of Kenyans. However, since its inception, the scheme has faced multiple challenges, including technical failures, delayed reimbursements, and lack of clarity on how funds are disbursed.
Several clinical officers have also voiced concerns over SHA’s implementation, claiming they have been sidelined despite being crucial service providers. Their grievances include being excluded from the scheme, which they argue violates a previously signed return-to-work agreement that promised promotions, medical cover, and job confirmations.
“We demand immediate recognition and inclusion in the SHA system. Clinical officers play a vital role in healthcare delivery, and excluding us from this scheme is unfair and unacceptable,” one union representative stated.
With hospitals facing financial distress, some have already been auctioned due to unpaid debts, while others have had to lay off employees to stay afloat. Many doctors have now resorted to demanding cash payments before treating patients, as relying on government reimbursements has become unsustainable.
“Why is it that the Treasury does not value the lives of Kenyans?” RUPHA questioned in its statement, emphasizing the urgent need for government intervention.
If the crisis remains unresolved, thousands of patients who rely on SHA could be left without access to critical healthcare services. Stakeholders are now urging the government to take immediate action to prevent further disruption and ensure that hospitals can continue providing essential medical care to all Kenyans.
