Private hospitals give SHA 14 days to clear Sh76 billion debt
According to the association, hospitals are owed Sh33 billion in unsettled NHIF claims and a further Sh43 billion under SHA. Out of the NHIF debt, Sh15.2 billion is tied to 83 large hospitals, with the rest distributed across 2,600 smaller facilities.
Private hospitals have issued a 14-day ultimatum to the Social Health Authority (SHA) and the Ministry of Health demanding payment of what they describe as huge pending claims amounting to Sh76 billion under the current SHA scheme and the defunct National Hospital Insurance Fund (NHIF).
The demand was made through the Rural and Urban Private Hospitals Association of Kenya (RHUPHA-Kenya), which warned that facilities across the country are facing severe financial strain as reimbursements remain delayed or unpaid.
According to the association, hospitals are owed Sh33 billion in unsettled NHIF claims and a further Sh43 billion under SHA.
Out of the NHIF debt, Sh15.2 billion is tied to 83 large hospitals, with the rest distributed across 2,600 smaller facilities. RHUPHA pointed out that 23 of the 83 hospitals are public institutions, which account for 10 per cent of the NHIF debt.
RHUPHA has given SHA two weeks to clear all pending NHIF liabilities in line with the presidential directive of March 5. The association also wants at least half of the Sh43 billion under SHA paid immediately and a mechanism created on the SHA portal to allow hospitals to resubmit valid claims that were previously rejected.
It further called for the establishment of a Dispute Resolution Tribunal to address issues of suspensions, downgrades, and investigations into hospitals. The group also demanded transparency through the publication of detailed claims data, including the amounts paid, total claims submitted, approvals, and payout ratios.
“Kenyan hospitals remain in severe financial distress due to delayed and inadequate reimbursements by the Social Health Authority (SHA). In particular, general inpatient and surgical claims have stagnated, with hospitals reporting 10–20 per cent payout ratios in these categories,” the statement read.
The association criticised Health Cabinet Secretary Aden Duale’s decision to reject Sh10.6 billion worth of SHA claims, saying it was unfairly hurting compliant hospitals. It also accused the authority of making arbitrary changes, including deleting bed capacities, downgrading facilities, and suspending hospitals without following due process as required by the Fair Administrative Action Act.
“Hospitals continue to face blanket rejection of claims without an avenue to submit clarifications or supporting documents. Publish the names of the 24 hospitals you sent to DCI and the monies you seek to recover from them,” RHUPHA said.
The association also raised concerns over SHA’s financial model, noting that the authority faces a monthly shortfall of between Sh2.7 billion and Sh3.5 billion. SHA currently collects about Sh5.4 billion per month while claims filed by hospitals average Sh8.7 billion.
“As of end August 2025, healthcare providers had submitted Sh96.2 billion in claims. SHA has only paid Sh53 billion, leaving an outstanding obligation of Sh43 billion. The ‘Register Now’ drive without a matching ‘Contribute Today’ campaign has been a policy misstep. Hospitals are being flooded by patients while facilities lack medicines, staff, and operating cash flow,” RHUPHA said.
