Healthcare providers given 12 days to sign new SHA contracts

Health Cabinet Secretary Aden Duale. [File, Standard]

Healthcare providers have 12 days to transition to the new Social Health Authority (SHA) contracting framework despite opposition from private hospitals over some provisions of the proposed agreements.

This comes after the Authority on Friday officially launched the 2026-2029 contracting cycle, dubbed HAKIKA.

The new cycle, which begins on October 1, will cover services financed through the Social Health Insurance Fund (SHIF), Primary Healthcare Fund (PHCF), Emergency, Chronic and Critical Illness Fund (ECCIF) and Public Officers Medical Scheme Fund (POMSF).

SHA opened its electronic contracting platform on Thursday, requiring providers to make fresh applications for the new cycle.

Speaking during the launch in Nairobi, Health Cabinet Secretary Aden Duale said facilities should not wait until the last week of September to complete the process, directing them to update their compliance documents, review contracts, activate their provider portals and prepare their staff for the transition.

“Submit your expression of interest on the e-contracting platform, ensure you know your customer documents and your licences are up-to-date, review your contract, activate your provider portal access, brief your staff and test your systems,” Duale told providers.

He said the new contracting framework was intended to move SHA and healthcare facilities away from a transactional relationship towards a partnership, while addressing concerns that have emerged during the authority's first two years.

“We are moving from a transactional relationship to a process, to partnership; from uncertainty to clarity and from suspicion to trust,” he said.

Duale acknowledged that the relationship between SHA and healthcare providers had been marked by disputes over claims processing, reimbursements, pre-authorisation, documentation, audits, credentialing, communication and the adoption of digital systems.

He said SHA also had legitimate concerns over incomplete or inaccurate claims, compliance, verification of services and protection of public funds.

“Responsibility to provide clarity has a responsibility to communicate consistently; other responsibility to process claims efficiently; other responsibility to offer technical support,” he said.

He urged providers to submit accurate claims, maintain proper records and uphold professional and financial integrity.

The CS said SHA would publish the benefits covered and payment schedules, provide reasons for rejected or reduced claims, establish downtime procedures for system failures and ensure emergency care is not delayed by authorisation procedures.

“Where a service was genuinely delivered, our instinct should be to correct, not to reject it,” Duale said.

However, the rollout comes against the backdrop of resistance from private and faith-based hospitals over aspects of the proposed contracts.

In a circular issued this week, hospital associations including the Kenya Association of Private Hospitals (KAPH), Rural and Urban Private Hospitals Association of Kenya (RUPHA) and Christian Health Association of Kenya (CHAK) raised concerns over the proposed terms and sought more time to review them. SHA had earlier extended the deadline for stakeholder comments to September 17.

The associations have particularly questioned provisions linking SHA's obligation to pay claims to the availability of funds and parliamentary appropriation. They have also raised concerns over deductions, claims management and the risk of facilities carrying the financial burden when payments are delayed.

The hospitals have said they support Universal Health Coverage and the Social Health Insurance Act but want adequate time to understand the obligations before committing their facilities.

“It is not our intention to delay implementation, but to ensure that when our members sign, they do so with full understanding of, and confidence in, the terms they are accepting,” the associations said in their earlier submission.

“A hurried review risks generating comments of lower quality, or facility-level decisions taken without a full understanding of the obligations assumed, with resultant defaulting on the contractual obligations,” added the hospitals in a statement.

Duale, however, said the authority had considered feedback from providers across the country and would continue engaging them during implementation.

He said the new digital platform should make contracting more transparent by allowing facilities to track their applications and see what action is required at every stage.

Duale also warned that partnership would not mean lowering standards, saying SHA would continue to enforce quality requirements, fight fraud and abuse, and hold both providers and its own officers accountable.

“The partnership between the providers and SHA is not lowering the standards. We will continue to insist on quality. We will continue to protect the integrity of public funds,” he said.

“The success of the cycle will therefore not be measured by the number of contracts signed. It will be measured by whether Kenyans experience better access, better quality, less disruption and greater financial protection when they need healthcare,” Duale added. SHA boss Mercy Mwangangi said the policy will ensure the healthcare providers have greater visibility of their contracted services, tariffs and payment details, while improving dispute resolution and accountability. The new system, she noted, will also help ensure beneficiaries receive care only from facilities authorised to offer specific services, as SHA works to improve quality of care and meet its 90-day payment cycle“This is a platform that would really help cure a lot of the problems that we’ve been having when it comes to contracting and contracts management and tariffs," she said.