The government has an outstanding debt of Ksh10 billion to healthcare providers, while various state corporations owe Ksh25 billion to the now-defunct National Health Insurance Fund (NHIF), according to Acting Social Health Authority (SHA) CEO Robert Ingasira.
Speaking on the matter, Ingasira confirmed that discussions are underway to resolve the pending payments, particularly with the Rural and Private Hospitals Association of Kenya (RUPHA).
The association, which suspended services for a second consecutive day, has cited financial constraints affecting several healthcare facilities.
Ingasira acknowledged the backlog in payments but assured stakeholders that efforts are ongoing to clear the debts.
“We recognize the outstanding payments. Initially, the debt stood at Ksh19 billion, but Ksh9 billion was disbursed between October and November,” he stated.
He added that a detailed breakdown of disbursements since October 1 would help clarify what has been settled and what remains unpaid.
Contrary to reports that the NHIF system had been shut down, Ingasira confirmed that it remains operational.
“The NHIF system is still in use, as it is crucial for reconciling outstanding debts. The contract with the service provider has not been terminated, as the data it holds remains essential for finalizing payments to healthcare facilities,” he explained.
Addressing concerns about primary healthcare funding, Ingasira noted that the government had allocated Ksh4 billion to the sector in the current financial year. Of this, Ksh1.3 billion was disbursed in November.
“Capitation is determined based on population data, and facilities submit reports detailing the number of patients treated and services provided. New facilities have also been onboarded, and Level 4 hospitals, previously excluded, are now allowed to offer primary healthcare services,” he said.
The remaining Ksh2.4 billion will be used to settle claims from facilities that provided services between October and December, pending verification of their reports.
“We are finalizing discussions with some facilities, and we expect to disburse the remaining funds this week or next week,” Ingasira added.
Ingasira clarified that SHA manages three distinct funds, each legally designated for specific purposes and cannot be reallocated.
“The funds designated for primary healthcare cannot be used for other purposes. Out of the Ksh4 billion allocated, the Ministry of Health has already released Ksh3.7 billion to SHA. Of this, Ksh1.3 billion has been paid out, and the remaining Ksh2.4 billion will go toward clearing pending claims,” he explained.
The suspension of services by RUPHA has entered its second day, significantly affecting operations at various healthcare facilities.
RUPHA chairperson Brian Lishenga warned that unresolved issues within the healthcare system are putting patient care at risk and jeopardizing the sustainability of many hospitals.
“These challenges have been ignored for too long, endangering patients and threatening the viability of healthcare facilities,” Lishenga said.
According to RUPHA, SHA system failures and delayed payments have affected numerous hospitals.
“Only 54 percent of hospitals have received payments from SHA, while 89 percent have reported failures in the SHA portal. Additionally, 83 percent have encountered difficulties verifying patient eligibility due to system glitches,” Lishenga stated.
As the crisis escalates, healthcare providers are urging the government to urgently address systemic failures to prevent further disruptions in service delivery.
