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Kenya’s bold promise of universal health coverage under the Social Health Authority (SHA) is fast unraveling—at least for those tasked with delivering care. Over 9,000 public, private, and faith-based health facilities across the country are bracing for another financial juggling act, this time relying on a staggered government payout meant to soothe weeks of operational panic.
The SHA announced that verified claims would be reimbursed in two waves—one on July 14, the other on July 21. But the damage from weeks of delay may already be done.
Behind the scenes, private and public clinics alike are barely staying afloat. A recent industry report revealed that only 20% of contracted facilities under the Primary Health Care (PHC) model received their full monthly reimbursements. The rest? Deep in debt, ducking suppliers, and some—already shuttered.
SHA’s payment bottlenecks have turned healthcare into a high-stakes survival game. Thirty-six percent of surveyed facilities have resorted to debt just to keep their doors open. Nearly a third are at risk of defaulting on these loans. One in ten is facing lawsuits or threats of auction. One percent are already casualties—closed and forgotten.
The hardest hit are lower-tier facilities. Level 2 hospitals, typically serving rural and semi-urban communities, reported the highest rate of non-payment. Level 3 hospitals, often seen as the backbone of regional health services, are mired in confusion over payment timelines.
The Rural and Urban Private Hospitals Association of Kenya (RUPHA) issued a grim warning: unless the government restores consistency and trust in the system, more facilities could fall.
Health Cabinet Secretary Aden Duale admitted to Parliament that 9,365 facilities are under the SHA scheme—5,219 public, 3,650 private, and 496 faith-based. They collectively serve more than 6.2 million Kenyans. But what’s universal in principle isn’t yet sustainable in practice.
Outpatient services are supposedly free under the PHC Fund, and more specialised treatments—dialysis, maternal care, imaging, and cancer therapy—are covered under the Social Health Insurance Fund (SHIF). But when clinics can’t afford basic supplies, all the coverage in the world means little.
SHA CEO Mercy Mwangangi’s reassurance is cold comfort to facilities on the edge. Even with July 14 and 21 now marked for payment, trust is eroding. Clinics want more than a calendar—they want transparency, accountability, and a government that doesn’t wait until providers are knee-deep in debt to act.
For patients, this is more than policy—it’s about life and death. Delayed reimbursements don’t just hurt hospitals, they turn routine treatment into a luxury. And in a system that promised to fix that very injustice, this may be the ultimate betrayal.
Next steps must include:
-Immediate audits on payment backlogs.
-Fast-tracked reimbursement for lower-tier facilities.
-Standardised claims processing across all hospital levels.
-Legislative safeguards to prevent operational shutdowns due to SHA delays.
-A nationwide status report on facilities at risk of closure.
If this is the future of healthcare in Kenya, it’s running dangerously behind schedule.
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