Kenyan doctors' during a nationwide strike. Photo/Courtesy
By Daisy Okiring
Kenya’s health sector is facing a looming crisis after the Rural Private Hospitals Association of Kenya (RUPHA) issued a 14-day strike notice to the Social Health Authority (SHA), demanding the immediate settlement of outstanding claims amounting to Ksh.43 billion.
Speaking in Nairobi on Friday, RUPHA Chairperson Brian Lishega warned that the debt burden was crippling healthcare facilities across the country. He said hospitals were struggling to operate without essential medicines, adequate staffing, or cash flow, with many on the brink of collapse.
“Kenyan hospitals remain in severe financial distress due to delayed and inadequate reimbursements by the Social Health Authority. This is the lived reality of hospitals, not the narrative of ‘timely payments’ presented to the public,” Lishega said.
According to RUPHA, healthcare providers had submitted claims worth Ksh.96.2 billion by the end of August 2025. However, only Ksh.53 billion has been paid, leaving a backlog of Ksh.43 billion that continues to grow.
Hospitals warn of collapse amid rising debt
Lishega revealed that at least 50 percent of claims from Level 2 to Level 4 hospitals remain unpaid, while some surgical and inpatient claims have payout ratios as low as 10 to 20 percent. This, he said, was pushing many smaller facilities into financial ruin.
The association further accused SHA of running an unsustainable financing model, collecting Ksh.5.4 billion monthly against claims worth Ksh.8.7 billion—a monthly shortfall of about Ksh.3.5 billion. Lishega argued that initiatives like Proxy Means Testing and Lipa SHA Pole Pole had failed to increase contributions from the informal sector, leaving the system underfunded.
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RUPHA also highlighted the government’s failure to honor a Presidential Directive issued on March 5, 2025, which ordered the settlement of National Health Insurance Fund (NHIF) debts below Ksh.10 million. NHIF liabilities currently stand at Ksh.33 billion, while SHA owes hospitals Ksh.43 billion, raising the total debt owed to Ksh.76 billion.
The largest unpaid balances affect major public and mission hospitals, including Kenyatta National Hospital (Ksh.1.58 billion), Moi Teaching and Referral Hospital (Ksh.1.23 billion), Kenyatta University Teaching, Referral and Research Hospital (Ksh.540 million), and Nakuru County Hospital (Ksh.297 million).
RUPHA’s demands to avert a health system collapse
To avert the looming strike, RUPHA has set out five demands to the government and SHA. These include the immediate settlement of NHIF liabilities in line with the presidential directive, payment of at least 50 percent of SHA’s Ksh.43 billion backlog, and activation of a claims clarification mechanism on the SHA portal.
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The association is also pushing for the establishment of a Dispute Resolution Tribunal to oversee suspensions and downgrades of facilities, as well as the transparent publication of claims data to ensure accountability.
Lishega further accused SHA of rejecting valid claims months after submission, arbitrarily deleting bed capacities, and suspending facilities without due process, actions he said violate the Constitution and the Fair Administrative Action Act.
“Without action, access to healthcare will collapse under the weight of debt. A Marshall Plan is urgently required to clear debts and redesign SHA sustainably,” he warned.
If no action is taken within 14 days, private hospitals have vowed to withdraw services, a move that could paralyze healthcare delivery nationwide.
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