Kenya’s universal health coverage struggles as hospitals face KSh 76 billion in unpaid claims, forcing cash-only services and risking closures. Delays, downgrades, and opacity have left providers in crisis and patients—especially in rural areas—with dwindling access.
Kenya’s ambitious promise of universal health coverage is under severe strain, with unpaid hospital bills reaching KSh 76 billion and the gap between government assurances and the ground reality widening. Nearly six months after President William Ruto ordered the clearing of National Health Insurance Fund (NHIF) liabilities, private hospitals nationwide have yet to receive payment, threatening their financial stability and undermining healthcare access. The Rural & Urban Private Hospitals Association of Kenya (RUPHA)—which represents over 700 facilities—warns that persistent debts, split between NHIF arrears and new obligations under the Social Health Authority (SHA), leave hospitals unable to sustain services and push providers toward insolvency.
While the SHA was established in October 2024 to streamline reimbursement and transparency, hospitals continue to report significant delays and opaque reporting practices. Official figures cite payments to individual facilities but omit key details like the number of claims filed, approved, or the actual payout ratios, thus masking the true scale of unpaid claims. Since SHA’s inception, hospitals have filed KSh 93 billion in claims but received only KSh 50 billion in reimbursements.
The crisis has hit primary care facilities in pilot counties—Mombasa, Kirinyaga, Embu, and Nandi—particularly hard. These were chosen for a digital payments program meant to simplify health reimbursements, but the new system has resulted in further bottlenecks, worsening delays and causing staff demoralization and resource shortages. The government’s promise of free primary care now appears ever more hollow as facilities struggle to function.
Compounding the issue, SHA has removed more than 10,000 inpatient beds and 3,500 maternity beds—mainly from private providers—from its portal, downgrading or erasing facilities despite their valid licenses. This has reduced the health system’s recognized capacity and reimbursement flow, effectively stripping them of entitlement to payment and, according to hospitals, violating constitutional principles of fair administrative action.
Private hospitals, which deliver about half of Kenya’s healthcare, report discriminatory treatment, with many claims subjected to prolonged reviews under the guise of fraud prevention. In reality, such controls are being used to delay payments rather than curb abuse, while unaffordable insurance premiums and flawed means-testing models further burden citizens.
In rural counties, where private hospitals are often the only providers, cash-only policies or service closures now threaten patient access for the poorest communities. The mounting debt jeopardizes the credibility of the government’s universal healthcare pledge. Hospitals are urging a comprehensive bailout, transparency in claims and payout ratios, prompt reimbursements, and an end to selective downgrading of private facilities. They demand due process and fair enforcement to restore trust and ensure the survival of health services across Kenya.
