The Social Health Authority (SHA) has announced that it will complete payments to healthcare providers for services rendered under the national health insurance scheme within the next three weeks.
In a statement issued on Tuesday, July 22, SHA Chief Executive Officer Mercy Mwangangi stated that the authority is in the process of thoroughly reviewing all claims submitted by contracted health facilities by July 1.
Over 9,000 healthcare facilities across the country are involved, and the review is to ensure that all claims meet SHA’s rules and guidelines.
Dr. Mwangangi confirmed that the reviews for both the Primary Healthcare Fund and the Maternity Package have already been finalized, and the related payments were scheduled to be released today, July 22.
She added that SHA is currently reviewing additional claims for inpatient services, surgical packages, and other medical services. These payments, she assured, will be processed and disbursed within the next three weeks.
So far, the authority has already paid out Ksh3 billion to health facilities after successfully completing claim verifications for accident and emergency services, haematology and oncology, and renal care treatments.
“SHA is now reviewing all remaining claims to ensure they meet the terms set in the contracts and the access rules outlined under Social Health Insurance Regulations 59 and 61,” said Dr. Mwangangi.
Growing Concern Over Delayed Payments
This update from SHA comes at a time when there is growing concern over delayed payments, which many facilities claim have negatively affected their ability to offer timely and quality healthcare.
A recent report by the Rural and Urban Private Hospitals Association of Kenya (RUPHA) revealed worrying findings—only 20% of health facilities enrolled under SHA’s Primary Health Care (PHC) model have been receiving their full monthly reimbursements.
The Ministry of Health reports that 9,365 health facilities are currently part of the SHA scheme. This includes 5,219 public facilities, 3,650 private hospitals, and 496 faith-based health centres.
RUPHA’s study further revealed the impact of the financial strain:
- 36% of facilities had turned to loans or credit to keep running,
- 30% were in danger of defaulting on those loans,
- 13% faced the risk of property auctions,
- 9% had been taken to small claims courts by suppliers, and
- 1% had already closed down due to lack of funds.
Progress in Coverage and Treatment
Health Cabinet Secretary Aden Duale, also speaking on July 22, provided an update on the progress of the national health insurance rollout.
According to CS Duale, over 24 million Kenyans have so far registered for the scheme. Out of these, 4.5 million people have accessed treatment for common illnesses and maternity care, while another 2.2 million have benefited from specialised medical services.
Dr. Duale assured the public that the government is committed to improving the national healthcare system through reforms that ensure better service delivery and timely compensation for healthcare providers.
SHA’s promise to finalise all pending payments is seen as a key step toward restoring the financial stability of healthcare facilities and building public trust in the country’s reformed health insurance system.
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