By Vincent Kariuki
The Rural & Urban Private Hospitals Association of Kenya (RUPHA), representing over 700 private and faith-based healthcare facilities, has suspended credit services to the Social Health Authority (SHA) effective midnight, September 19, 2025.
The decision follows the expiry of a two-week notice issued on September 5, highlighting unresolved concerns that threaten the sustainability of healthcare providers.
RUPHA’s grievances center on SHA’s failure to address critical issues. On August 27, 2025, Health Cabinet Secretary Aden Duale ordered the rejection of Kshs 10.6 billion in medical claims, bypassing Clause 8.2.2 of the SHA Provider Contract, which mandates written communication within 14 days for claim rejections. Many rejections were untimely, leaving hospitals unable to address concerns and facing significant financial losses.
Discrimination in claims settlement is another issue, with SHA allegedly hand-picking payments instead of using an automated “first-in, first-out” system, creating inequity and uncertainty. Historical debts, some dating back to 2017, remain unpaid despite a March 2025 Presidential directive to settle claims of Kshs 10 million and below.
Larger claims, totaling Kshs 15 billion for 82 facilities, face deliberate delays despite SHA’s capacity to expedite adjudication.RUPHA also accuses SHA of weaponizing fraud allegations to reject valid claims, while failing to establish the Dispute Resolution Tribunal mandated by the Social Health Insurance Act.
Additionally, arbitrary downgrades by SHA and the Kenya Medical Practitioners and Dentists Council (KMPDC) have erased thousands of beds, including 3,478 maternity beds (18.6% of national capacity) and 1,080 delivery beds (28.6%), severely impacting access in rural counties like Mandera and urban informal settlements.
The financial strain is stark: SHA owes hospitals Kshs 43 billion, with Kshs 24 billion in limbo. Monthly claims of Kshs 8.8 billion outstrip SHA’s Kshs 5.4-6 billion revenue, leaving hospitals to subsidize the system by Kshs 76 billion. The “Lipa Pole Pole” initiative has failed, with salaried Kenyans bearing 96% of contributions.
RUPHA demands immediate settlement of claims below Kshs 10 million, reversal of mass rejections, establishment of the Dispute Resolution Tribunal, and a review of SHA’s financing model to include the informal sector. It also calls for settling arrears before migrating Teachers’ and Police medical schemes and reversing bed erasures.
Dr. Brian Lishenga, RUPHA Chairman, warned that the collapse of private and faith-based hospitals, which provide nearly half of Kenya’s healthcare, could dismantle Universal Health Coverage.
RUPHA seeks partnership but insists on trust, fairness, and adherence to the law to sustain the system.