SHA: Teachers, police in fresh dilemma

By Newsflash Team

Healthcare facilities under the Rural Urban Private Hospitals Association (Rupha) have declared they will not treat teachers and police officers once their medical schemes transition to the Social Health Authority (SHA).

Rupha chairperson Dr Brian Lishenga made the announcement at a press conference in Nairobi on Monday, September 22, saying the migration planned for December should not proceed until Medical Administrators Kenya Limited and Minet clear outstanding debts owed to hospitals.

The Medical Administrators Kenya Limited scheme covers at least 450,000 teachers and expires on November 30. “We don’t want to face a crisis similar to that of the defunct NHIF, where schemes were shifted before arrears were settled,” said Dr Lishenga.

According to him, most hospitals have gone for more than a year without payment for teachers’ and police schemes. He estimated the police scheme at Sh8.9 billion annually and the teachers’ scheme at around Sh20 billion.

Dr Lishenga also noted that part of the Sh33 billion NHIF debt had built up when the two schemes were transferred to private insurers. “Instead of paying debts, they were simply moved. We won’t allow a disorderly transition. They must join SHA on a clean slate,” he stressed.

He confirmed hospitals will now require patients to pay cash, following an earlier decision by Rupha to suspend credit facilities to SHA. The stance came just 16 days after the expiry of a 14-day notice issued to the authority.

“SHA has failed to address the issues we raised two weeks ago. We’ve raised them repeatedly for nearly a year. Hospitals are now at risk of financial paralysis,” Dr Lishenga said, warning that lack of funding would cripple access to essential supplies, equipment and staff.

Credit suspended, reforms demanded

The Rupha chairperson accused SHA of rejecting valid claims and mislabelling them as fraudulent, while denying approvals for renal and cancer patients. He cited the case of 70-year-old cancer patient Gatamu Waigwa, who exhausted his benefits and was denied treatment until the next financial year unless he paid out of pocket.

“This shows SHA’s financing model is unsustainable. We can no longer extend loans or credit to an unreliable borrower,” he said. “As SHA nears its one-year mark, it must be reformed if it is to survive.”

Dr Lishenga urged Health Cabinet Secretary Aden Duale to reverse the rejection of Sh10.6 billion in claims, calling it unfair and contrary to SHA’s provider contracts. “Hospitals have been denied the right to clarify or remedy situations, resulting in huge losses. Talking of verification without action is unjustifiable,” he said.

Read more: Teachers oppose rush to SHA plan

Despite suspending credit, Rupha facilities will continue offering emergency services and critical care. However, they will not extend credit to SHA until reforms are undertaken.

“We ask for humility from both the Cabinet Secretary and SHA. Let them go back to the drawing board and remodel the system. It’s only one year old, not too late to fix. But for us, it is too late to extend any more credit,” Dr Lishenga stated.

The announcement comes days after TSC acting CEO Eveleen Mitei told the National Assembly Education Committee of plans to transfer teachers to the Public Officers’ Medical Scheme under SHA.