Patients struggle as Health ministry, private hospital wrangle on unpaid billions

Rural and Urban Private Hospitals Association Chairman Brian Lishenga during an interview at The Standard Group Offices on February 25,2025. [Benard Orwongo,Standard]

A tussle between the Ministry of Health and private hospitals over a Sh30 billion debt has left patients seeking Social Health Authority (SHA) services in despair.

The ministry is pleading with the hospitals to continue providing SHA services as it develops a new payment model to clear National Health Insurance Fund (NHIF) debt, but the facilities have maintained their indefinite suspension of services.

“For SHA itself, we have been able to pay, but the challenge is NHIF debt which we are having the plan to pay. We are optimistic that we shall agree and services will resume," said Health Cabinet Secretary Deborah Barasa.

Dr Barasa said the ministry was also auditing claims to avert corruption.

But the Rural and Urban Private Hospitals Association of Kenya (Rupha) Chairperson Brian Lishenga said patients will have to pay cash.

Dr Erick Musau, chairman of the Kenya Association of Private Hospitals (KAPH), said hospitals cannot offer quality services because they owe suppliers and are not able to pay staff and buy commodities.

“Most providers have not received money. We have only received 30 per cent of SHA claims from October last year to January. There is discrepancy. Ministry says they are paying, but even the portal is not showing what providers have paid for and that they haven't,” he said.

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KAPH represents at least 350 hospitals, among them high-end Level 5 and 6 facilities in Nairobi.

"As an association, we suspend credit arrangement. Hospitals are open but operating on cash basis. We are getting out of credit arrangement that doesn't favour us,” said Musau.

SHA Chief Executive, Robert Ingasira, acknowledged that the scheme owes hospitals Sh19 billion. Of the claims, Sh9 billion has been paid.

“We've asked Rupha and hospital associations to work with branches to reconcile debts. One of the issues is fast track reconciliation,” said Ingasira.

On Primary Healthcare Fund, Ingasira acknowledged that the National Treasury allocated Sh4 billion, of which Sh1.3 billion has been dispersed.

But even with the balance, the CEO noted that under SHA, three designated funds exist, restricting the reallocation of money across different funds.

Ingasira said by yesterday, SHA had settled Sh5.92 billion, benefiting 4,700 facilities, with a cumulative Sh17.12 billion cleared between October and January.

But Rupha said there has been discrepancy on what the ministry claims to have paid and what has been dispersed to hospitals.

Total accumulated claims, verified and unverified, according to Lishenga, comes to a total of Sh30 billion.

The transition committee report indicated that NHIF owed 2.7 million claims which were still in process, claims SHA is required to reconcile.

Apart from Sh30 billion, NHIF is reported to have archived Sh6.9 billion for Linda Mama, Edu Afya and inpatient medical care.

Even as CS Barasa and SHA maintain they are instantly paying claims, Lishenga said money for primary healthcare fund and provision of services at Level Two and Three hospitals has not been paid.

While pushing for pay, Lishenga said in a meeting held on Monday, Medical Services PS Harry Kimtai revealed that the government does not have money to pay the claims.

Further, the hospitals pleaded with the PS to provide an acceptable plan of payment, but he maintained “they cannot plan when they've no resources”.

In the meeting, it was agreed that state agencies, including the Teachers Service Commission and the police, should remit money owed to NHIF to have the hospitals paid.

“PS said it'll take time. We did not agree. If claims are undisputed and providers and payer agree, the claim should be settled,” said Lishenga.During the PS meeting, it was agreed that reconciliation should be handled within 30 days

But Lishenga claimed that SHA staff is too lean to handle the reconciliation of claims. Only 53 per cent of facilities have completed the reconciliation exercise.