RUPHA SHED LIGHT ON THE CRISIS FACING HEALTH CARE IN THE COUNTRY

Members of RUPHA address the media in Nairobi, highlighting the crisis facing hospitals and the status of healthcare in the country.”

By: Glad Tv Kenya reporter 

Kenya’s healthcare sector has been thrown into uncertainty after private and faith-based hospitals announced they will no longer extend credit services to the Social Health Authority (SHA). The facilities say they are drowning in debt and unpaid claims that have crippled operations nationwide.

The suspension, declared by the Rural & Urban Private Hospitals Association of Kenya (RUPHA), affects more than 700 hospitals across the country. RUPHA said the drastic measure follows years of unresolved grievances with SHA and the expiry of a two-week notice that had been issued earlier this month.

“Kenya’s hospitals are on the verge of collapse. Essential supplies are running out, staff morale is breaking, and patients are increasingly exposed to out-of-pocket payments,” RUPHA said in its statement. “If the private and faith-based sector which provides nearly half of Kenya’s healthcare collapses, Universal Health Coverage will collapse with it. The progress of the last 20 years will be wiped out.”

Key issues raised were:

1. Breach of Contract on Claims Rejection
   On August 27, 2025, Health Cabinet Secretary Aden Duale rejected medical claims worth KSh 10.6 billion without following due process. RUPHA said this violated Clause 8.2.2 of the SHA Provider Contract, which requires written communication within 14 days and an opportunity for providers to clarify or remedy claims.

2. Discrimination in Claims Settlement
   Instead of the automated “first-in, first-out” digital adjudication system, RUPHA alleged that SHA introduced human interference, resulting in favoritism, delays, and uncertainty.

3. Failure to Settle Historical Liabilities
   Hospitals are still carrying debts dating back to 2017. A presidential directive issued in March 2025 ordered the immediate payment of verified claims worth KSh 10 billion and below, but SHA allegedly ignored the directive. As of September 2024, 465 facilities had claims above KSh 10 million, with just 82 facilities owed KSh 15 billion.

4. Weaponization of the War on Fraud
   While RUPHA said it supports anti-fraud efforts, it accused SHA of rejecting billions in valid claims under the guise of fraud. The association also criticized SHA for failing to establish the legally required Dispute Resolution Tribunal under Section 44 of the SHI Act, leaving hospitals without an avenue to contest unfair suspensions or claim rejections.

5. Unprocedural Downgrades and Bed Erasures
   SHA and the Kenya Medical Practitioners and Dentists Council (KMPDC) were accused of arbitrarily erasing hospital beds, crippling service delivery. The losses include:

• 3,478 maternity beds (18.6% of national capacity),
• 1,080 delivery beds (28.6% of the national total),
• 10,000 inpatient beds.

These downgrades, RUPHA said, have hit rural counties such as Mandera, Turkana, Wajir, and Garissa hardest, as well as urban informal settlements where lower-level facilities are vital.

6. Unsustainable SHA Debt
   As of August 2025, hospitals are owed KSh 43 billion, with another KSh 24 billion in claims under review. RUPHA noted that while hospitals continue to provide services, they are effectively underwriting the system by absorbing KSh 5.4–6 billion monthly in unpaid claims.

To reinstate credit services to SHA, hospitals have issued six key demands:

1. Immediate settlement of all claims worth KSh 10 million and below, as directed by the President.
2. Reversal of mass rejections and a fair opportunity for hospitals to clarify claims.
3. Establishment of an independent Dispute Resolution Tribunal.
4. Urgent review of SHA’s healthcare financing model to reduce overreliance on salaried workers and strengthen contributions from the informal sector.
5. Settlement of outstanding debts under Teachers and Police medical schemes before their planned migration to SHA in December 2025.
6. Reversal of arbitrary downgrades and bed erasures, in line with the 2021 Medical Institutions Rules.

RUPHA warned that unless these issues are addressed, the healthcare sector faces imminent collapse. The association noted that critical facilities in both rural and urban areas are already struggling with shortages of essential supplies, delayed staff salaries, and mounting operational costs.

“The collapse of this sector would mark the end of Universal Health Coverage in Kenya,” the association concluded.