The Rural & Urban Private Hospitals Association of Kenya (RUPHA) has issued operational guidelines for its member facilities ahead of the impending suspension of Social Health Authority (SHA) services, set to take effect on Monday, February 24, 2025.
In a statement released on Sunday, RUPHA emphasized that the guidelines aim to ensure that patients are not abandoned while also safeguarding healthcare providers from financial collapse.
Under the new directives, private hospitals will continue providing emergency care to stabilize patients, irrespective of their insurance status. Once stabilized, patients who rely solely on SHA or MAKL medical covers will be referred to a hospital of their choice that still accepts these covers.
“Emergency cases shall not be denied care under any circumstances,” RUPHA stated, reinforcing the ethical obligation of medical facilities to prioritize life-saving treatments.
Additionally, patients who were admitted under SHA or MAKL before February 24, 2025, will continue receiving treatment under the existing terms until they are discharged. Likewise, scheduled outpatient appointments arranged before this date will be honored.
RUPHA has urged hospitals to inform their patients about the suspension in a professional and procedural manner, explicitly advising against issuing public notices or social media announcements to prevent panic and misinformation.
For patients affected by the suspension, several alternative care options have been outlined. These include cash payments for those who can afford continued treatment, referrals to hospitals that may still accept SHA/MAKL coverage, or using alternative private insurance schemes if available.
Post-suspension, in-patient admissions under SHA or MAKL will only be allowed if these insurers provide an upfront payment guarantee. Otherwise, patients will need to arrange for alternative payment methods.
Hospitals will, however, continue to submit claims for services rendered before the suspension date, ensuring proper documentation to facilitate payments.
RUPHA’s decision to enforce these guidelines follows prolonged financial struggles due to unpaid claims under the new healthcare scheme. The association has maintained that it remains open to dialogue with the government, provided authorities commit to resolving their grievances. They demand the settlement of a Ksh.30 billion debt in NHIF arrears, proposing a maximum repayment period of three months.
Since its introduction in October 2024, SHA has faced persistent operational challenges, with Kenyans voicing frustrations over inefficiencies in the system. As the deadline approaches, affected patients and healthcare providers alike are left navigating uncertain territory.
