Assessing SHA's Progress

A recent survey by the Rural and Urban Private Hospitals Association of Kenya (Rupha) highlights the increasing difficulties in implementing SHA reforms. While there have been strides in e-contracting and patient verification, these gains are being overshadowed by significant setbacks in claims management, reimbursement models, and the financial stability of healthcare providers.

“The overall SHA transition score has fallen from 46% to 44%, signaling a regression in implementation. Key service delivery areas such as financial health, system functionality, and outpatient reimbursement have deteriorated. Despite improvements in e-contracting and patient verification, these gains are outweighed by mounting challenges in claims management and provider financial stability," said Dr. Brian Lishenga, Rupha's chairperson.

Financial Struggles for Healthcare Providers

Financial instability remains a major concern for healthcare providers, with 46% of facilities reporting irregular payments, slightly down from 48% in December. Smaller hospitals, particularly level two and three facilities, are bearing the brunt, with 64% reporting non-payment. The delayed and unclear reimbursement process is placing immense strain on private and faith-based healthcare institutions.

Rising Costs for Patients

Out-of-pocket costs for patients are increasing, with 40% facing higher medical expenses. This burden is particularly severe in private and faith-based facilities, further limiting access to care.

“These rising costs put significant financial pressure on patients and worsen access to care, especially in facilities already struggling with payment delays," the report states.

Training Gaps and System Challenges

As SHA continues to update its systems, the demand for training among healthcare providers remains high. The survey found that 43% of providers require training during system updates, with in-person training requests increasing from 32% to 37% and online training requests rising to 19%. However, difficulties in navigating the SHA portal persist, highlighting the need for more effective training and support.

Funding Shortages and Workforce Gaps

One of the most pressing issues facing SHA is inadequate funding. While 19.4 million Kenyans are registered under the scheme, only 3.3 million actively contribute, leaving a massive funding gap. This challenge is further exacerbated by a Sh30.9 billion debt inherited from NHIF, which continues to strain SHA’s limited resources.

Kenya is also grappling with a critical shortage of health workers. As of January 2025, the country needed an estimated 70,000 additional health professionals to meet demand, with projections suggesting this gap could exceed 114,000 by 2030.

Operational Inefficiencies and Limited Coverage

Operational inefficiencies are another major hurdle for SHA expansion. Patients in public hospitals report long wait times, frequent service delays, and technical failures. Meanwhile, private healthcare facilities report that SHA coverage is largely limited to specific groups, such as civil servants, forcing many Kenyans to pay out-of-pocket for services that NHIF previously covered.

Rising Healthcare Costs and the Risk to Universal Health Coverage

According to the latest Kenya National Bureau of Statistics Consumer Price Indices and Inflation Rates 2025 Report, healthcare costs in Kenya have risen by 3.3% in the past year. With limited SHA coverage and delayed reimbursements, the risk of reduced access to care is growing, posing a significant threat to Kenya’s Universal Health Coverage goals.

As SHA navigates these challenges, urgent reforms are needed to ensure financial sustainability, enhance system functionality, and improve access to quality healthcare for all Kenyans.