The Social Health Authority (SHA) has issued a notice to empanelled healthcare providers countrywide regarding verified claims under the new national health insurance scheme.

In a statement issued on Monday, July 14, by SHA Chief Executive Officer Mercy Mwangangi, the government assured over 9000 healthcare facilities that verified claims would be processed and disbursed in two phases.

According to the SHA CEO, the first phase will be disbursed on Monday, July 14, while the other disbursement would take effect a week later, on July 21.

“We wish to inform contracted Health Care Providers that reviewed and verified claims payments under Primary Health Care (PHC) and the Social Health Insurance Fund (SHIF) will be processed and disbursed on 14th and 21st July 2025,”  Mwangangi's statement read.

A hospital ward in Kenya.

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Kenyans.co.ke/Murang'a GH

The announcement came amid emerging concerns from a section of healthcare providers over delays in reimbursement. Some facilities have, in the recent past, lamented over strained operations brought about by cash crunches.

A recent study by the Rural and Urban Private Hospitals Association of Kenya (RUPHA) recently uncovered a worrying trend, revealing that only 20 per cent of facilities contracted under SHA’s Primary Health Care (PHC) model received full monthly reimbursements.

“About 36% of the facilities had resorted to debt, 30% were on the risk of defaulting these loans, 13% were at risk of auction, 9% faced small claims court cases from suppliers, and 1% had already shut down operations,” the report said.

This dynamic ultimately condemned many healthcare facilities to operational strain, with lower-tier health facilities the most affected.

Another issue that presented itself from the survey was the fact that payment clarity and consistency varied across facility levels. Notably, level 2 hospitals received highest share of non-payments while level 3 facilities grappled with a high level of uncertainty cases.

According to figures presented to Parliament last week by Health Cabinet Secretary Aden Duale, a total of 9,365 facilities are currently contracted under the SHA scheme. These include 5,219 public facilities, 3,650 private hospitals, and 496 faith-based institutions.

The CS estimated that combined, these facilities serve over 6.2 million Kenyans under Primary Healthcare Fund (PHCF) and Social Health Insurance Fund frameworks.

Under PHCF, Kenyans can access outpatient services at no cost. SHIF, meanwhile, covers more specialised treatments including dialysis, imaging, maternal care, and cancer treatment
 

The Social Health Authority(SHA) building, October 1, 2024.

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Social Health Authority