The Ministry of Health has reported that hospitals across Kenya have lodged claims totaling KES 16.5 billion through the Social Health Authority (SHA) portal since October 1, 2024. The claims, submitted by various health facilities, amount to 735,931 in total.
According to Dr. Patrick Amoth, Director-General at the Ministry of Health, the claims primarily come from secondary and tertiary hospitals, with primary health facilities mostly offering free services. The Ministry has emphasized the importance of this new system in improving efficiency and transparency in the country’s healthcare financing.
In addition to claims processing, the Ministry of Health has revealed that 8,761 health facilities, representing 55% of active facilities in Kenya, have successfully enrolled in the SHA Health Provider Portal. However, only 88 of these facilities have had successful log-ins so far. The Ministry is working to ensure more providers gain access and utilize the platform effectively.
Dr. Amoth highlighted that inpatient services account for the highest claim values, followed by renal care services. Since October, over one million Kenyans have accessed primary healthcare services through SHA, with the number steadily increasing each month. Furthermore, a total of 335,278 pre-authorizations have been raised, mainly from Level 4 and Level 5 hospitals.
One of the key improvements in the SHA system has been the reduction in pre-authorization processing time. Previously, the average turnaround time stood at 355 minutes (just under six hours). However, as of this month, the time has been significantly reduced to 87.6 minutes. Outpatient-related pre-authorizations now take an average of 12.9 minutes, while inpatient-related pre-authorizations have improved from six hours to three hours.
The government remains committed to enhancing the efficiency and accessibility of SHA. Dr. Amoth reiterated that efforts are underway to optimize specialist pre-authorization processes, ensuring patients receive timely care for advanced medical procedures. The Ministry is working closely with regulatory bodies to streamline approvals and remove unnecessary administrative hurdles.
To further strengthen the SHA framework, the Ministry of Health is in the final stages of drafting a Quality of Care Policy and Bill. This legislation aims to standardize healthcare quality, improve the empanelment process, and enhance accountability in healthcare delivery. By aligning with SHA objectives, the policy will promote high-quality, patient-centered care and drive continuous improvements in service delivery.
The Ministry continues to encourage all Kenyans to enroll in SHA to benefit from improved healthcare access and financial protection. As the system evolves, further enhancements are expected to ensure seamless service delivery and better health outcomes nationwide.
