Nairobi: A crisis is brewing in Kenya’s top National Referral Hospitals as Chief Executive Officers (CEOs) warn that the Social Health Authority (SHA) is underfunding key medical procedures, causing facilities to run services at a loss.
According to Kenya News Agency, CEOs from the hospitals held a closed-door meeting at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) on Saturday, where they drafted a joint petition demanding urgent revision of reimbursement rates and expansion of services covered under the new health insurance scheme. The delegation was led by Kenyatta National Hospital Acting CEO, Dr. Richard Lesiyampe, who said public hospitals were already struggling to stay afloat under the new health financing model.
Dr. Lesiyampe warned, “SHA must work for us to survive. We have no way out. If the system remains as it is, hospitals will not be able to sustain services. We have raised several concerns that require immediate action.” At the center of the standoff is the widening gap between SHA reimbursements and the actual cost of treatment, particularly surgeries requiring specialized implants.
The CEOs revealed that they were being forced to cover the financial shortfall, pushing facilities deeper into financial strain. They noted that several common surgical procedures were not listed in the SHA payment schedules, yet hospitals offer them daily. Without a billing pathway, these services are being provided at a loss, and if this trend continues, hospitals could eventually become incapable of offering essential services.
Adding to the frustration are millions of shillings in arrears owed to facilities by both the defunct NHIF and its successor SHA. Hospitals are demanding that all pending dues be settled and a clear policy established for resolving rejected claims, which they say disrupt cash flow and delay the procurement of critical supplies.
Furthermore, the CEOs proposed changes to services covered under the scheme, asking the Authority to increase dialysis sessions from two to three per patient weekly, enhance coverage for kidney transplant patients, and restructure maternal and neonatal service payments for better reimbursement. The petition also demands the removal of rules that only pay for certain procedures if performed outside the country, despite the same services now being available locally.
To advance negotiations, the CEOs have formed a technical committee comprising surgeons and SHA officials to address contentious issues and align the Authority’s policies with hospital realities. Their warning comes in the wake of SHA replacing NHIF as Kenya’s primary health insurer, with promises of universal access to care. However, referral hospitals warn that without urgent amendments, this promise may collapse under financial pressure.