This was the week that the Rural and Urban Private Hospitals Association of Kenya raised the alarm that the Social Health Authority is crippling private, community, and faith based hospitals.
With over 700 members nationwide, their concerns highlight the urgent need to rethink SHA’s role in our healthcare system. Hospitals are struggling under delayed reimbursements and that is a clear pointer to who truly sustains the system.
Despite a directive to pay on the 14th of every month, SHA continues to stall private healthcare. To date, claims worth Kshs 93 billion have been submitted, but only Kshs 50 billion, just 53 percent, has been reimbursed, leaving Kshs 43 billion in unpaid liabilities. This is concerning considering that money is going into private entities that prioritize profit before healthcare.
SHA’s publication of reimbursement data lacks crucial context. Without showing total claims and payout ratios, the numbers cannot serve as a genuine measure of transparency. Regardless of how they are presented, those numbers mean something for a nation conscious of public health.
Meanwhile, primary healthcare reimbursements in pilot counties remain unpaid. This is virtually free money considering it is a basic service that public hospitals can handle with ease. Such failure undermines the credibility of free primary healthcare both at the SHA level and at the hospital level.
Claims of arbitrary deletions and downgrading of facilities on the SHA portal, despite valid licenses, violate Gazette Notices like No. 269 of 2021 as well as constitutional safeguards of due process. This would not be the case if it were solely a public sector driven agenda.
Health will continue to suffer because of a lack of confidence building. The system has created mistrust and inefficiency at the frontline of healthcare delivery, especially for private hospitals. This is one more reason why they need to exit a public space that was only meant to facilitate rather than depend on them.
The crisis in the private sector is compounded by the hangover of NHIF arrears that once kept them afloat. One hundred and sixty eight days after the President directed that all pending bills be cleared, hospitals are still waiting. They must now wait longer and should retire from competing with the public sector. Their objectives are worlds apart and they do not complement each other.
NHIF is owed Kshs 33 billion, and SHA liabilities now stand at Kshs 43 billion, a staggering Kshs 76 billion in total that could have done more for the public sector. These unpaid debts have left facilities on the brink of insolvency, a clear sign they are sustained by the public sector.
This threatens the sustainability of essential services for those who should otherwise afford private hospitals. It is more reason for a call to draw distinct lines, with collaboration but not dependency.
To make matters worse, private hospitals, which deliver half of Kenya’s health services, are in that position only because of State choice. Government is complicit in this mess because it controls resources that define the entire health environment. As they face blatant discrimination, with legitimate claims trapped in endless medical reviews lasting months, private facilities suffer in a way that would not occur in public hospitals.
The tragedy is not just in unpaid bills but in the squandered opportunity for government to improve public healthcare. The Kshs 93 billion in claims could already have transformed Kenya’s public health system into a world class model.
With that amount, the country could build and equip several hospitals on the scale of Kenyatta National Hospital in every region so that Kenyans would no longer need to travel to Nairobi for specialized care.
It could modernize all county referral hospitals, ensure that each has CT scans and MRI machines, expand intensive care units, and keep essential medicines permanently in stock. That level of investment could also finance a massive training program for specialists, including oncologists, neurosurgeons, and cardiologists. It could stem the brain drain of doctors leaving for better opportunities abroad and position Kenya as a regional hub for advanced medical care.
It would mean Kenyans no longer have to fly to India or South Africa for treatment because the expertise and technology would be available here at home. Most importantly, such investment would make it possible to retire private medical schemes for civil servants which consume billions every year and fuel elitism within the State.
These schemes create a privileged class separated from ordinary citizens who must endure long queues in underfunded hospitals while the private sector continues to bleed the public system.
Redirecting resources into a strong, efficient, and well resourced public health system would close this gap and guarantee equal access to quality care for all. If properly managed, Kenyans could enjoy a system where world class treatment is the standard, not the exception, and where every citizen, regardless of income or status, can trust public hospitals with their health and dignity. The money is there; what is missing is accountability, prioritization, and political will.
The truth is that if SHA cannot pay promptly and fairly, it should be confined to public hospitals. Private, community, and faith based facilities require a framework that respects their investments and sustains their services without unnecessary bureaucratic sabotage.
SHA was meant to anchor universal health coverage, but it cannot succeed by bankrupting half the system simply because of an organized private sector competing against the public sector that SHA was created to strengthen.
Kenya needs a sustainable financing model that treats private providers as partners, not adversaries, but without dependency on public funds. If private hospitals collapse, the public sector will only grow stronger owing to the vast resources available to it.
This does not mean collapse of healthcare for millions of Kenyans. On the contrary, the dream of universal health coverage will finally be achieved and not remain an empty promise.
Lastly of all sectors, why is it only Healthcare that is partly privatised by the state ? Government actively Subsidises private sector.
