Kenya's private health providers, represented by the Kenya Healthcare Federation (KHF), have issued a dire warning regarding unprecedented financial distress. This crisis is directly linked to substantial unpaid claims by the Social Health Authority (SHA), which has inherited a significant debt burden from the now-defunct National Health Insurance Fund (NHIF). KHF, whose network provides approximately 60 percent of medical care in Kenya, states that its members are on the verge of collapse due to these ballooning debts.

The federation has accused the government of failing to adhere to President William Ruto’s directive from March 5, which mandated the settlement of all NHIF debts below Sh10 million. The memo from KHF highlights that the accumulated debt has reached an unsustainable level, threatening to severely impact healthcare access and quality across the country. Consequences for providers include forced closures, staff layoffs, and auctions, with many struggling to meet their contractual obligations. Furthermore, the sector is plagued by hostility, unexplained claim rejections, and blanket accusations of fraud, which have severely eroded investor confidence.

In response, KHF has proposed several critical measures to address the crisis. These include issuing default notices to patients covered by non-performing SHA-managed funds, requiring patients to sign liability undertakings, and engaging lawmakers to advocate for greater accountability. The federation also demanded increased transparency from SHA regarding claim payments, collections, and the performance of its administered schemes, alongside the establishment of a clear appeals process for rejected claims. KHF cautioned that a lack of payment from SHA or other payers would force a reversion to a cash-basis system for client engagement, potentially leading to catastrophic out-of-pocket expenses for Kenyans.

Adding another layer to this deepening crisis, it has emerged that a multi-billion shilling digital superhighway system, developed by the Social Health Authority with an investment of Sh104 billion, has collapsed. This system was specifically designed to curb fraudulent claims and streamline the claims process. Its failure has not only exposed the claims verification process to manipulation but is also estimated to have led to losses of approximately Sh24 billion. In a significant setback, the SHA has now been compelled to revert to manual verification of claims, reversing its earlier digital investment and potentially exacerbating inefficiencies and payment delays.

Despite these immense challenges, KHF reiterated its commitment to ensuring access to care, emphasizing the irreplaceable and indispensable role its members play within the health system. The federation's stern statement followed closely on the heels of Health Cabinet Secretary Aden Duale's dismissal of calls for his resignation over alleged fraud at SHA, during which he accused some lawmakers of blackmail and conflicts of interest, asserting that some legislators’ own health facilities were implicated in the controversial SHA payment claims saga.