Kenya’s promise of universal health coverage now reads as bitter irony, with officials sermonizing about “free primary healthcare” even as hospitals stagger under KSh 76 billion in unpaid bills.
- •Nearly six months after President William Ruto ordered the clearance of all pending NHIF liabilities, a lobby group for private hospitals has issued a statement affirming that not a single hospital has received payment.
- •The Rural & Urban Private Hospitals Association of Kenya (RUPHA), which represents more than 700 facilities nationwide, said the shortfall threatens to push many providers into financial insolvency.
- •Meanwhile, a growing number of healthcare providers have already turned to cash-only payments, undermining access for patients who depend on insurance reimbursements.
The unpaid obligations are split between the old National Health Insurance Fund and the recently created Social Health Authority (SHA), which was designed to streamline financing under the government’s flagship universal coverage plan.
Hospitals are owed KSh 33 billion in NHIF arrears and a further KSh 43 billion in SHA reimbursements. SHA was set up in October 2024 with promises of faster reimbursements and clearer accounting. Instead, hospitals report long delays and opaque reporting. The authority publishes figures for payments made to individual facilities but without disclosing how many claims were filed, how many approved, or the payout ratios.
Healthcare providers say this gives a false impression of efficiency while concealing the scale of unpaid claims. Since its inception, hospitals have submitted KSh 93 billion in claims, but only KSh 50 billion has been reimbursed.
Primary care facilities in four pilot counties including Mombasa, Kirinyaga, Embu, and Nandi have been especially hard hit. These counties were chosen to test the government’s Digital Superhighway program, which aims to digitize health payments. Instead of easing the process, the shift has created new bottlenecks and delays leading to persistent non-payment of primary care reimbursements in these areas. This has left facilities under-resourced, staff demoralized, and the government’s pledge of free primary healthcare increasingly hollow.
Debts, Deletions, and Downgrades
The crisis extends beyond delayed reimbursements as the hospitals’ association claims that the Social Health Authority has deleted more than 10,000 inpatient beds and nearly 3,500 maternity beds from its official portal, downgrading or erasing facilities despite their holding valid licenses from the Kenya Medical Practitioners and Dentists Council (KMPDC). The deletions, affecting mainly private providers, have reduced the recognized capacity of the health system and limit the flow of reimbursements.
Under Kenyan law, level 3C facilities, classified as inpatient hospitals, and Level 2 dispensaries are permitted to provide maternity services. By removing them from the registry, authorities have effectively stripped facilities of their entitlement to payment, a move providers argue breaches constitutional safeguards on fair administrative action.
Private hospitals, which account for about half of Kenya’s healthcare services, say they are bearing the brunt of discriminatory treatment. Large volumes of legitimate claims for surgeries and admissions have been placed under prolonged medical review, in some cases stretching over four months. The group argues that fraud controls have been weaponized to delay reimbursements rather than prevent abuse.
“While RUPHA supports efforts to fight fraud, the Ministry of Health has weaponized fraud controls instead of addressing the flawed Proxy Means Testing Model and unaffordable annual premiums that burden Kenyans,” Dr. Brian Lishenga, Chairman of RUPHA said.
The financing gap has immediate consequences for patients countrywide. In rural and underserved counties such as Wajir, Mandera, Marsabit, and Samburu, private hospitals are often the only functioning providers. As facilities switch to cash-only models or close down services, access to care for some of the country’s poorest communities is rapidly narrowing.
The mounting debt also threatens the credibility of the universal health coverage program, a central pledge of the administration. While the government continues to showcase digital platforms and insurance reforms as milestones, providers say the gap between official rhetoric and the on-the-ground reality is widening.
Hospitals are now calling for a comprehensive rescue package and are calling for a full disclosure of claims submitted and payout ratios, timely reimbursements, and a Marshall Plan–style financing scheme to clear arrears before facilities collapse. They are also demanding that the government stop downgrading private facilities without due process and end what they describe as selective enforcement against non-state providers.
