Private Hospitals Issues 14-day Strike Notice over KSH 43 Billion Unpaid SHA Claims
NAIROBI, Kenya, Sep 7- Rural and Urban Private Hospitals Association of Kenya (RUPHA) has issued a 14-day strike notice if the Social Health Authority (SHA) fails to settle NHIF liabilities, Pay 50% of all claims from lower-levels facilities (Level 2-4).
Brian Lishenga, Chairperson RUPHA while addressing the media on Friday noted that Private healthcare sector is at a breaking point with months of unresolved issues with SHA which have put facilities and most importantly patients at risk.
According to RUPHA, SHA’s current design is unsustainable with monthly deficits as it collects about Ksh 5.4 billion per month but generates Ksh 8.7 billion in claims leaving a Ksh 2.7-3.5 billion hole monthly.
They further highlighted that proxy means testing has failed to increase informal sector contributions with Lipa SHA Pole Pole stalling due to limited public education calling out Authority for forcing Kenyans to pay annual lump-sum premiums which is unrealistic given shrinking household budgets.
“The ‘Register Now’ drive without a matching ‘contribute Today’ campaign has been a policy blunder, Hospitals are being flooded by patients while facilities lack medicines, staff and operating cash flow”.
Additionally, they noted delay of primary healthcare reimbursements across several counties with PHC -per- person payment is falling due to SHA registrations have plateaued while outpatient visits continue to rise against a fixed global budget.
The Association further expressed frustration over Presidential directive issued on 5th March 2025 to settle NHIF debts of Ksh 10 million and below has not been honoured as NHIF liabilities stands at Ksh 33 billion, SHA liabilities Ksh 43 billion in total hospitals are owed Ksh 76 billion on unsustainable debt load.
“We remind the public that NHIF debt are a matter of public record, largest debts are owed to public mission hospitals which includes Kenyatta National Hospital (Ksh 1.58B), Moi Teaching and Referral Hospital (Ksh 1.23B), Kenyatta University Teaching Referral and Research Hospital ( Ksh 540M) and Nakuru County Hospital (Ksh 297M).
RUPHA reiterated that Hospitals continue to face ‘blanket of rejection’ of valid claims without an avenue to submit clarifications or supporting documents as it violates clause 8.2 of provider’s contract which requires SHA to provide pre-authorization feedback within 72 hours and rejection notice within 14 days.
“Today, claims are being rejected months after submission without due process denying hospitals rightful payments”.
The Association demands immediate settlement of NHIF liabilities, payment of at least 50% of the Ksh 43 Billion outstanding SHA liabilities within 14 days, Activation of clarification mechanism in SHA portal to enable facilities to resubmit valid but rejected claims, constitution of the dispute resolutions tribunal and transparent publication of claims data showing not only amounts paid, but also total submitted, approved and payout ratios.
“If no action taken by the government within the 14 days Hospitals will scale down services”.
