The Social Health Authority (SHA) has assured health facilities in the country that all pending payments under the national health insurance scheme will be cleared within the next three weeks.
Speaking today , July 22, SHA CEO Dr. Mercy Mwangangi stated that the Authority is currently reviewing claims submitted by more than 9,000 contracted hospitals and clinics for services provided up to July 1.
Dr. Mwangangi noted that the Authority has already completed the verification of claims under the Primary Healthcare Fund and the maternity package. Payments for these services were scheduled to start on Tuesday.
She added that claims related to inpatient care, surgeries, and other medical packages are still under review and will be settled within three weeks.
“So far, we’ve disbursed Ksh3 billion to health facilities whose claims for accident and emergency, cancer care, dialysis, and other urgent services have been verified,” said Mwangangi.
SHA says the payment process is guided by Social Health Insurance Regulations, which require claims to be checked thoroughly to ensure they meet set standards before funds are released.
The announcement comes as many health facilities raise concerns over delays in receiving payments, saying it has affected their operations and ability to offer quality care.
A recent survey by the Rural and Urban Private Hospitals Association of Kenya (RUPHA) revealed that only 20% of facilities under SHA’s primary care model had received full reimbursements for monthly services.
The same report painted a worrying picture:
- 36% of the hospitals had taken loans to stay
- afloat
30% were at risk of defaulting on those loans - 13% faced possible auction
- 9% were being sued by suppliers
- 1% had already closed down
The SHA scheme currently has 9,365 contracted facilities across Kenya, including 5,219 public hospitals, 3,650 private facilities, and 496 faith-based institutions.
Despite the payment delays, Health Cabinet Secretary Aden Duale said the insurance scheme has already benefited millions.
According to him, 24 million Kenyans have enrolled so far, with 4.5 million receiving treatment for common illnesses and maternity care, while 2.2 million have accessed specialized services.
