RUPHA suspends SHA services over unpaid claims, reimbursement model

Social Health Authority offices in Nairobi. [File,Standard]

The Rural & Urban Private Hospitals Association of Kenya (RUPHA) has announced an indefinite suspension of services under the Social Health Authority (SHA) insurance scheme starting February 24, citing unpaid claims and an unsustainable reimbursement model.

RUPHA, which represents private and faith-based hospitals, said the government's failure to settle Sh30 billion in arrears and address operational concerns had made it impossible to continue offering services.

"The continued failure to resolve critical challenges in the SHA transition is directly endangering patient care and hospital sustainability," said RUPHA Chairman Brian Lishenga.

"Hospitals have lost staff, defaulted on loans, and faced medicine shortages due to delayed payments."

Hospitals have struggled with unpaid National Health Insurance Fund (NHIF) claims dating back to 2017, pushing many to financial distress.

RUPHA noted that pharmaceutical suppliers had blacklisted hospitals, tax liabilities had mounted despite unpaid claims, and specialist doctors remained without pay for years.

SHA, which replaced NHIF, has declined to take responsibility for pending payments, further straining the sector.

The latest SHA transition report found that 89 per cent of hospitals were unable to process reimbursements due to nonfunctional claims portals, while 54 per cent had not received payments since December.

Under SHA's outpatient model, hospitals would receive less than Kshs 75 per patient per month. RUPHA called this "unrealistic," saying it was impossible to pay staff, procure drugs, or maintain operations under such terms.

"We refuse to put Kenyan lives at risk," said Lishenga. "The reimbursement model is financially unsustainable and threatens service delivery."

RUPHA also withdrew from the Medical Administrator Kenya Limited (MAKL) scheme, which covers teachers and police officers, citing 11 months of unpaid claims, unexplained fee deductions, and preferential treatment of MAKL-owned clinics.

The association demanded that the government either settle NHIF arrears or provide a transparent payment plan, revise the SHA reimbursement model, and ensure timely MAKL payments.

Patients seeking treatment under SHA at private and faith-based hospitals will have to pay in cash starting 24 February.

RUPHA expressed regret over the decision but said hospitals could not continue offering services without reforms.

"We stand ready to work with the government on real solutions," said Lishenga. "But hospitals cannot subsidise a broken system at the expense of patient safety."