The Senate has taken action against the Social Health Authority (SHA) over delays in releasing more than Sh9 billion owed to county governments, a backlog that continues to strain healthcare services in many parts of the country.

The Senate Public Investments and Special Funds Committee has directed SHA Chief Executive Officer Mercy Mwangangi to appear before it and provide a full update on the unpaid remittances.

The lawmakers want the SHA to present a status report, clear payment timelines, and details of amounts still pending for all counties.

“This committee will invite SHA CEO to provide a status report, payment schedule and balances to all county hospitals,” said committee vice chairperson Eddy Oketch.

The call comes as governors push for a financial arrangement that would ease pressure on county health systems. Led by Makueni Governor Mutula Kilonzo Jnr, who also chairs the Council of Governors’ Legal Affairs Committee, the county chiefs want the funds owed by SHA to be redirected to the Kenya Medical Supplies Authority (Kemsa) to clear counties’ debts to the agency.

“We are proposing a debt swap. Let the money that NHIF or SHA owe the facilities be given to Kemsa so that services are not interrupted,” said Mutula.

He revealed that counties are owed over Sh9 billion by the SHA, funds that were initially meant to be paid by the former NHIF before it was dissolved. At the same time, counties owe Kemsa close to Sh4 billion. Mutula warned that the standoff has led to a supply freeze by Kemsa, further crippling health services in the counties.

Only Mombasa and Makueni have no outstanding bills with Kemsa, while the rest continue to suffer from delays in drug deliveries and other essential medical supplies.

Mutula said the health function remains underfunded despite being devolved, making it difficult for counties to meet the growing demand for services.

“We are facing many challenges because of the budget. The health function has not been properly costed, and that is why we have budgetary challenges to fully perform this function,” he said.

In Makueni, he noted that 38 per cent of the total county budget is directed to the health sector, employing more than half of the county’s workforce.

However, many of the county’s 242 health facilities are severely understaffed and ill-equipped to handle the volume of patients.

“I have 242 health facilities in Makueni. Out of that, about 150 have only one nurse—one nurse attending to more than 2,000 patients every month. It is hectic,” he said.

Counties across the country are dealing with similar problems, including a lack of qualified health personnel, poor infrastructure, and critical shortages of drugs and equipment. Frequent breakdowns in supply chains, theft of medicines, and weaknesses at Kemsa have made the situation worse.

Mutula said some counties have had to rely on private suppliers to continue operating, despite high costs. To reduce losses and improve efficiency, his administration has embarked on a plan to digitise inventory systems in hospitals.

Senators who attended the meeting expressed concern over the crisis and promised to advocate for increased funding to counties. They questioned why the national Ministry of Health continues to hold more than Sh100 billion in its budget despite its reduced operational role under devolution.