Private hospitals across the country will suspend services under the Social Health Authority (SHA) scheme starting Monday, September 22, 2025, after the government failed to settle a Sh76 billion debt within a 14-day notice period.
The Rural and Urban Private Hospitals Association (RUPHA) chairperson, Brian Lishenga, said facilities will no longer serve patients on credit through SHA following the expiry of the ultimatum issued on September 5.
“Our notice expires tonight, and from Monday morning, we will suspend credit services to SHA,” Lishenga said on Friday, confirming that Kenyans covered under the scheme will be forced to either seek treatment in public hospitals or pay cash.
He expressed disappointment that the government had not moved to resolve the standoff, warning that many private facilities were close to shutting down.
According to Lishenga, the debt includes Sh33 billion carried forward from the defunct National Hospital Insurance Fund (NHIF) and Sh43 billion accumulated under SHA.
“Hospitals are in crisis. Patients are struggling in many facilities; unless something changes, we risk mass closures, leaving Kenyans unable to access healthcare,” he warned.
The association had cautioned that facilities were drowning in debt, unpaid claims and arbitrary suspensions, stressing that they could not continue offering services under such conditions.
“Kenyan hospitals remain in severe financial distress due to delayed and inadequate reimbursements by the Social Health Authority. This is the lived reality of hospitals, not the narrative of ‘timely payments’ presented to the public,” Lishenga said.
He noted that nearly half of claims from lower-level hospitals remain unsettled, while payments for general inpatient and surgical claims range between only 10 and 20 per cent.
By the end of August, healthcare providers had filed claims worth Sh96.2 billion, of which only Sh53 billion had been cleared, leaving Sh43 billion outstanding.
Lishenga further explained that while SHA collects about Sh5.4 billion monthly, it faces claims of up to Sh8.7 billion, creating a Sh3.5 billion gap every month.
He accused the government of ignoring a presidential directive issued on March 5, 2025, which ordered the settlement of NHIF debts below Sh10 million. “Today, claims are being rejected months after submission, without due process, denying hospitals rightful payments,” he added.
Among the biggest unpaid balances are Kenyatta National Hospital (Sh1.58 billion), Moi Teaching and Referral Hospital (Sh1.23 billion), Kenyatta University Teaching, Referral and Research Hospital (Sh540 million), and Nakuru County Hospital (Sh297 million).
RUPHA is demanding urgent action, including the settlement of NHIF liabilities in line with the presidential directive, immediate payment of at least half the Sh43 billion owed under SHA, creation of a claims clarification mechanism on the SHA portal, establishment of a Dispute Resolution Tribunal, and transparent publication of claims data.
“Without action, access to healthcare will collapse under the weight of debt. A Marshall Plan is urgently required to clear debts and redesign SHA sustainably,” Lishenga said.
Despite the looming suspension, President William Ruto on Friday launched a programme to sponsor SHA coverage for 2.2 million vulnerable Kenyans, handing over a Sh4.4 billion cheque to kickstart the plan.
“We are paying for 558,000 households, translating to 2.2 million Kenyans. We have over 6,000 hospitals where Kenyans can access medical services, and this is anchored in law,” the President said during the launch at State House, Nairobi.
The government also unveiled a new framework allowing Kenyans to access medical services abroad through SHA.
Health Cabinet Secretary Aden Duale said 36 services not available locally had been identified and would now be offered overseas under the scheme.
“This is a preliminary list, as the process of identifying additional interventions is continuous and will be guided by a comprehensive Health Technology Assessment (HTA),” Duale explained.
He added that overseas referrals will go through peer review by the claims management office to confirm medical necessity. Currently, SHA has capped overseas claims at Sh500,000, though the amount may be revised after negotiations with foreign hospitals.
