The government has acknowledged the concerns raised by the Rural Private Hospitals Association (RUPHA) regarding SHIF reimbursement structures and operational processes.
In a press statement from the office of the Cabinet Secretary on Wednesday, the Ministry of Health, when giving the Taifa Care media update, noted that as a key stakeholder in the healthcare sector, RUPHA plays an essential role in extending health services to rural and underserved communities, complementing the efforts of public hospitals.
“The government remains committed to fostering a collaborative approach with private healthcare providers to enhance service delivery under the Social Health Authority (SHA),” the statement said.
The Ministry says that it has met and engaged with RUPHA, among other stakeholders, to address the concerns raised and that one of the key concerns raised by RUPHA relates to delays in claims processing and reimbursement for services rendered under SHIF and the PHC Fund.
“The Ministry has introduced clear guidelines for facility accreditation, standardised claims submission processes, and an enhanced digital system for real-time claim tracking. These measures are designed to eliminate past inefficiencies and ensure that all service providers receive their payments on time,” the statement said.
The Ministry has further emphasized the need for accountability and transparency in healthcare financing, noting that while the government is committed to prompt payments, facilities must also adhere to service quality standards and accurate documentation to facilitate faster reimbursements.
“SHA has since the inception of the programme paid the claims launched by the facilities promptly and while the law gives SHA 90 days to pay the claim, we clarify SHA has been paying for the verified claims monthly and the payments have been made up to the end of 31st January 2025,” the statement further said.
According to the Health Ministry, SHA payments have gone to Private, FBOs and Government facilities, including Sh 5.1 billion paid on Monday and the RUPHA facilities have been paid for all the claims up to the end of January 2025.
The Ministry says SHA inherited a substantial debt from the defunct NHIF, posing a significant financial challenge to the healthcare system and that the Ministry of Health has made considerable progress in addressing these outstanding obligations, having already paid Sh8.6 billion towards settling NHIF debts between September and December last year.
To ensure transparency and accuracy, the statement continued, SHA has been meticulously verifying NHIF claims and conducting reconciliations with each affected healthcare facility and the process involves rigorous validation to confirm legitimate claims before finalising payments.
“Once verification is complete and agreements are signed with the respective facilities, a structured settlement plan will be developed in consultation with contracted providers to clear the outstanding NHIF debt,” the statement further said.
The government, the statement noted, remains committed to continuous engagement with healthcare facilities and other stakeholders to address any emerging challenges through fostering collaboration and streamlining payment processes to ensure that healthcare providers are adequately supported.
Ultimately, the Ministry notes that all these efforts are aimed at safeguarding uninterrupted service delivery and upholding the quality of care under the Taifa Care model.
“The Ministry assures all stakeholders that it will maintain open communication and transparency throughout the debt settlement process to strengthen confidence in the health financing system.
By Wangari Ndirangu
