The Rural & Urban Private Hospitals Association of Kenya (RUPHA) has announced a suspension of Social Health Authority (SHA) services starting Monday, citing unresolved system failures and government inaction. The decision comes as frustrations mount over persistent technical and financial challenges, putting the health of thousands of Kenyans at risk.
Speaking to the press on Thursday, RUPHA Chairperson Dr. Brian Lishenga expressed deep concerns over the inefficiencies plaguing the SHA system, which have severely impacted service provision. He noted that a staggering 89% of facilities have reported SHA portal failures, while 83% of hospitals struggle with patient eligibility verification due to system glitches. Moreover, only 54% of hospitals have received payments from SHA, exacerbating financial strain on healthcare providers.
Dr. Lishenga highlighted key system challenges, including prolonged downtimes, delays in One-Time Password (OTP) verification, and difficulties in tracking claim approvals. He warned that these issues have worsened in the past month, threatening the sustainability of private hospitals.
“We have unpaid debt dating back to 2017, hospitals are facing bank defaults, we have stock-outs of essential medicines, and many consultants haven’t been paid for years,” he stated.
As a result, RUPHA has resolved to discontinue offering services under Medical Administrators Kenya Limited (MAKL), which handles medical schemes for police officers and teachers. This decision is expected to have far-reaching consequences, as the suspension could leave thousands of public servants without essential healthcare services.
“Without urgent intervention, teachers and police officers will be left without quality healthcare service,” Dr. Lishenga warned.
RUPHA has issued three key demands to the government: the immediate settlement of Ksh.30 billion in NHIF arrears, a revision and streamlining of SHA’s outpatient reimbursement model, and timely and fair payment of claims under MAKL.
Since its rollout in October 2024, the SHA scheme has been marred by inefficiencies, drawing criticism from both medical practitioners and patients. Clinical officers have been particularly vocal, protesting their exclusion from SHA services and the breach of last year’s return-to-work agreement. Their grievances include unfulfilled promises of promotions, comprehensive medical cover, and the confirmation of universal health coverage (UHC) staff into permanent and pensionable terms.
They are demanding immediate recognition and empanelment of all health providers licensed by the Clinical Officers Council. Additionally, they seek the reinstatement of pre-authorization rights for clinical officers, including specialists, to enhance service delivery.
As the suspension looms, pressure is mounting on the government to address these challenges and prevent a potential healthcare crisis.
