The Commission on Administrative Justice (Office of the Ombudsman) has expressed serious concerns over the recent announcement by the Rural Urban Private Hospitals Association (RUPHA) to suspend healthcare services across Kenya.
The commission says the move by the association arises from the failure of the Social Health Authority (SHA) to remit funds owed to private healthcare providers for services rendered under government-sponsored health programmes.It highlighted the accumulation of unpaid arrears by the National Health Insurance Fund (NHIF), totalling approximately KSh 30 billion, with some debts dating back to 2017.
“This financial strain has left hospitals unable to meet their obligations, including servicing bank loans, restocking essential medicines, and paying consultants,” stated the Commission.
“Compounding the issue is the current outpatient reimbursement model under SHA, which hospitals describe as unworkable and unsustainable,” added Commission chairperson Charles Dulo.
Dulo amplified technical inefficiencies within the SHA system raised by RUPHA, stating that these issues have further exacerbated the crisis. He noted that hospitals report frequent system downtimes, delays in One-Time Password (OTP) verification, and difficulties in verifying patient eligibility.
“Shockingly, 89% of facilities have experienced failures with the SHA portal, while 83% struggle to verify patient information due to persistent glitches. These technical hurdles have severely hampered hospitals’ ability to process claims and provide seamless services to patients,” he explained.
Despite repeated appeals regarding the existing challenges, the Ombudsman stated that the association’s concerns have largely been ignored, putting patients’ lives at risk and threatening the survival of private healthcare facilities.
Dulo reiterated that access to healthcare is a fundamental right enshrined in the Constitution, which guarantees every person the right to the highest attainable standard of health, including healthcare services. He stated that the threatened suspension of services by RUPHA members poses a significant risk to the public, particularly vulnerable populations who rely on those facilities for critical medical care.
“The suspension of healthcare services by private hospitals will have far-reaching consequences, including, thousands of Kenyans, especially those in rural and underserved areas, will be left without access to essential medical services,” he said.
According to the Ombudsman, the looming suspension will result in public hospitals, already overstretched, facing an overwhelming influx of patients, further compromising the quality of care.
There is also concern that ongoing treatments, including maternal care, chronic disease management, and emergency services, will be disrupted, potentially leading to preventable deaths.
“The inability to access healthcare will result in lost productivity and increased out-of-pocket expenses for Kenyans seeking alternative care,” added the chairperson.
The Commission is now urging the Social Health Authority to prioritize the remittance of all outstanding funds to members of the Rural Urban Private Hospitals Association (RUPHA) to ensure the continuity of healthcare services.
“The Social Health Authority should implement a reliable payment system to prevent future delays, ensure timely reimbursement for healthcare providers, and address the systemic challenges experienced by the service providers,” the Commission chairperson stated
