Over 100 privately owned rural hospitals in Kisii and Nyamira counties have been downgraded in what the Rural and Urban Private Hospitals Association of Kenya (Rupha) is calling an irregular and unexplained move by the Kenya Medical Practitioners and Dentists Council (KMPDC).

In a letter dated June 30, 2025, addressed to the KMPDC Chief Executive Officer David Kariuki, Rupha expressed deep concern over the reclassification of these health facilities from Kenya Essential Health Facilities (KEPH) Level 3 to Level 2, despite the hospitals having renewed their licences earlier this year under the same Level 3 category.

The downgrading has raised alarm because it directly affects the services the hospitals are allowed to offer and the financial support they are eligible to receive.

While Level 2 facilities offer only basic outpatient services such as treatment of minor ailments, immunisation, and referrals, often handled by nurses or clinical officers Level 3 hospitals provide a wider scope of care including maternity services, minor surgeries, inpatient care, and diagnostic laboratory services, requiring better staffing and infrastructure.

Crucially, the funding structure is also impacted. Level 3 hospitals qualify for both the Primary Healthcare Fund (PHCF) and the Social Health Insurance Fund (SHIF), while Level 2 facilities can only access PHCF.

PHCF, under the Social Health Authority, was designed to fund primary health services by paying facilities that deliver quality care to patients.

The downgrade now locks out affected hospitals from SHIF support, reducing their financial capacity and limiting access to broader healthcare services in the affected regions.

Rupha chairman Brian Lishenga criticised KMPDC’s decision, saying it was unfair for the council to accept payment from facilities for Level 3 categorisation and then alter their classification without notice, inspection reports, or the chance to correct any alleged non-compliance.

“It is our view that the recommended actions outlined in the checklist and risk rating framework were not followed,” said Lishenga.

He added that the affected hospitals were neither issued with inspection reports nor given an opportunity to address any shortcomings, in breach of the joint health inspection checklist and risk rating table developed to guide such decisions. According to Rupha, the absence of a clear appeal mechanism further exposes the lack of transparency in the downgrade process.

KMPDC is yet to issue a public response or explanation on the matter.