Hospitals under the Rural & Urban Private Hospitals Association Of Kenya (RUPHA) have temporarily suspended services under the Social Health Authority (SHA) insurance scheme and Medical Administrator Kenya Limited (MAKL) due to unresolved payment issues.
The suspension will take effect on Monday, February 24, 2025, according to guidelines issued to member hospitals by the body on Sunday, February 23, 2025.
Under the new guidelines, all facilities will continue providing emergency care to stabilize patients, in accordance with professional and ethical obligations. Once stabilized, patients who opt to exclusively use their SHA or MAKL medical covers shall be referred to a hospital of their choice.
“Emergency cases shall not be denied care under any circumstances,” RUPHA says.
Also, patients admitted under SHA or MAKL before February 24, 2025, will continue receiving care under the existing terms until discharge. Their treatment shall not be disrupted due to the suspension.
Also, scheduled outpatient appointments made before February 24, 2025, shall also be honoured under pre-existing terms.
“Patients shall be informed that SHA and/or MAKL services are unavailable and be given the following options; Cash payments for those who can afford to continue receiving care or referral to any hospitals that may continue accepting MAKL/SHA coverage,” RUPHA stated.
“No new SHA or MAKL-funded admissions shall be accepted from 24th February 2025, unless SHA or MAKL provide an upfront payment guarantee.Any newly admitted patients must be covered under alternative payment mechanisms.”
RUPHA says the suspension ensures that patients are not abandoned, while protecting healthcare providers from financial collapse.
Ksh30 billion debt
On Thursday, February 20, 2025, RUPHA revealed a Ksh30 billion debt owed by the government to the hospitals, which has made operations difficult.
“The Rural & Urban Private Hospitals Association of Kenya (RUPHA), representing hundreds of private and faith-based healthcare facilities nationwide, announces today (Thursday, February 20, 2025) a suspension of services under the Social Health Authority (SHA) insurance scheme beginning Monday, 24th February 2025.
“As healthcare professionals, our first duty is the welfare of our patients. However, the continued failure to address critical challenges in the SHA transition is now directly endangering the quality and sustainability of care in our hospitals. This decision has not been made lightly,” the RUPHA statement read.
RUPHA added that they have had engagements concerning SHA and two issues emerged making it impossible to continue treating patients who are covered by the scheme.
“It follows months of failed engagements, unfulfilled promises, and growing financial distress among hospitals, which now threatens the very survival of healthcare institutions across Kenya.
“Despite numerous engagements with government authorities, two critical issues remain unresolved, making it impossible to sustain operations: Settlement of historical NHIF arrears Amounting to Kshs 30 Billion and rejection of the Unworkable SHA Outpatient Reimbursement Model,” the statement added.
Crisis
RUPHA added that hospitals have been struggling majorly because of unsettled debts that amount Ksh30 billion.
“Kenyan hospitals across all ownership categories—public, private, and faith-based—are struggling under the weight of unpaid claims dating back to 2017, with the total amount now exceeding Kshs 30 billion.
“The consequences of this financial neglect are dire: massive job losses—many hospitals have lost doctors, nurses, and support staff due to inability to pay salaries; bank defaults—hospitals have defaulted on loans and overdrafts used to sustain operations while awaiting payments.
“Stockouts of essential medicines—pharmaceutical suppliers have blacklisted hospitals that cannot clear outstanding bills.
“Unpaid specialist doctors—many consultants have gone unpaid for years due to delayed reimbursements,” it concluded.
RUPHA also said that they will stop treating teachers and police officers amid the crisis around SHA.
