RUPHA Directs Private Hospitals To Charge All SHA Patients Cash
NAIROBI, Kenya, Sep 22- The Rural and Urban Private Hospitals Association of Kenya (RUPHA) has declared that its more than 700 member facilities will no longer extend healthcare services on credit to the Social Health Authority (SHA).
Though the standoff is centered on financial disputes and contractual breaches the immediate impact is likely to be felt by patients many of whom depend on private and mission hospitals across the country for essential care.
According to RUPHA, SHA’s financial troubles have reached crisis level Hospitals are currently owed Kshs 43 billion, with another Kshs 24 billion in claims under assessment. Without reimbursement, facilities warn that they cannot continue to operate sustainably, leaving Kenyans to either dig into their pockets or go without treatment.
The association pointed to weaknesses in the health financing model with nearly all contributions (96%) come from salaried employees, while workers in the informal sector contribute just 4% the imbalance has left the scheme over-reliant on a narrow funding base, making it difficult for SHA to meet its obligations.
Beyond unpaid claims, RUPHA accused SHA and the Kenya Medical Practitioners and Dentists Council (KMPDC) of slashing hospital capacity through arbitrary downgrades.
Their figures show a nationwide loss of: 3,478 maternity beds (18.6% of total). 1,080 delivery beds (28.6% of total). 10,000 inpatient beds across various hospitals.
For communities already struggling with access to care, this translates to longer waits, longer travel distances, and in the case of mothers-to-be, heightened risks during childbirth.
One of RUPHA’s strongest grievances is the rejection of Kshs 10.6 billion worth of claims following instructions from the Ministry of Health.
The association insists that this was done outside the agreed contract terms, denying hospitals the opportunity to defend or correct their submissions.
Additionally, RUPHA says SHA has turned the anti-fraud campaign into a blanket excuse to withhold legitimate payments without offering a fair mechanism for dispute resolution.
“The absence of the legally mandated tribunal has left hospitals with no independent avenue to challenge such decisions”.
While the dispute plays out between institutions, ordinary Kenyans are the ones who may suffer most families reliant on private or faith-based facilities will now need to pay upfront before receiving care.
For many, that is simply unaffordable, raising fears that healthcare will become inaccessible to vulnerable groups. This directly undermines the Social Health Insurance Act (SHIA), which was meant to guarantee affordable care for all citizens.
To restore services, RUPHA has issued six conditions which include : Payment of all claims under Kshs 10 million immediately as directed by the President earlier this year, Begin verification of larger claims within seven days, Cancel mass rejections and allow providers to respond, Establish the required independent tribunal and Review SHA’s financing structure to broaden the contribution base and reverse bed downgrades in line with the 2021 Medical Institutions Rules.
“Unless swift action is taken, the dream of equitable healthcare could unravel leaving patients to bear the burden of a system caught between policy ambitions and harsh economic realities”.
