CS Duale warns SHA will shut down clinics benefiting from NHIF fraud

Health Cabinet Secretary Aden Duale has issued a warning that the implementation of the Social Health Authority (SHA) will likely result in the closure of numerous private clinics operating in residential areas.

Speaking on Thursday, Duale noted that many of these clinics have thrived on fraudulent practices facilitated through the National Health Insurance Fund (NHIF), which SHA aims to eradicate.

 "The day the Social Health Authority (SHA) takes root, 60 percent of the clinics in our estates will close. Many hospitals, thought to be pillars of healthcare, have sustained themselves through fraudulent activities within NHIF," he said.

Meanwhile, outgoing Health Principal Secretary Harry Kimtai had condemned private healthcare providers for allegedly attempting to manipulate the government and public opinion by withholding essential services.

Addressing the issue on Monday, March 17, Kimtai cautioned that facilities failing to fulfill their constitutional duty to provide healthcare services could face severe repercussions, including challenges in renewing their licenses.

"Based on our analysis of available data, it's evident that a significant number of private facilities are not actively participating in outpatient care, which is fundamental to primary healthcare funding," Kimtai remarked.

The Ministry of Health has engaged in discussions with private hospitals to understand their reservations regarding the SHA model.

This follows a period of contention between the government and private healthcare institutions, highlighted by the Rural and Urban Private Hospitals Association (RUPHA) temporarily suspending SHA services in February, only to reverse the decision later due to presidential intervention.

A central concern raised by private hospitals revolves around unsettled debts, some dating back to 2017, which have strained their financial stability and affected crucial medical supplies.

Brian Lishenga, Chairperson of RUPHA, underscored these challenges, citing instances of financial distress and operational disruptions due to delayed payments.

Under the SHA framework, outpatient services are limited to a maximum charge of Sh2,000 per visit, with each beneficiary restricted to four visits annually at Level 2, 3, and 4 primary healthcare referral facilities.

Private hospitals argue that this fee structure poses sustainability challenges and threatens to further strain service delivery capabilities.