No pay, No service: Faith-based hospitals reject SHA contracts over Ksh.21B debt

Medical facilities under faith-based organisations and the Rural and Urban Private Hospitals Association of Kenya (RUPHA) have expressed concerns about the new Social Health Authority (SHA) contracts.

The two umbrella bodies maintain that the government has remained non-committal on the payment of over Ksh.21 billion owed to them by the now-defunct National Health Insurance Fund (NHIF).

The facilities have subsequently refused to sign the new contracts, highlighting that the binding agreements are designed to lock them out of service delivery and disenfranchise Kenyans seeking health care services.

The medical facilities have similarly taken issue with the government's failure to assure them that monies owed by the defunct NHIF will be paid under the new system, expressing fear that records of what is owed may be destroyed or lost in the transition.

"The reason why we worry about the transition with the claims pending is because there is going to be a system change and we have experience in the past where the system changes and the claims that were on process get lost and it takes time to have them reconstructed, added and paid. We’ve followed up as FBOs, and individually and as of now it's about Ksh.6 billion pending," said Dr. Samuel Mwenda, the Secretary-General of the faith-based organisations.

"Government owes health providers Ksh.30 billion, for us at RUPHA it's at Ksh.15 Billion. We have been categorical that there should have been a reconciliation so that each hospital can sign off before NHIF closes. We are concerned that someone could switch off the switch one day and all those claims will be lost," RUPHA Sec-Gen, Dr. Brian Lishenga, added.

The stakeholders maintain that even though they engaged the government in the policy formulation stage where they gave recommendations and voiced reservations regarding the contentious issues, the authority disregarded their opinions.

According to Mwenda, the referral system is a deliberate attempt to cripple their operations.

"Hospitals have been providing outpatient services for patients. In the new arrangement, outpatient services can only be provided in level 2 and 3 which means no other hospital can treat them. We can only treat referrals. The other challenge is there is no system for verification," he said.

"What they are saying is that level 5 hospital cannot provide direct outpatient care to those Kenyans who have been using that hospital. Kenyans don’t know this but under SHA, if you walk to that hospital, it is illegal for that hospital to provide you care," Lishenga added.

The two umbrella bodies, which constitute a sizeable portion of healthcare service providers in the country, say they will now treat patients on a cash basis, as there is currently no contract in place.

They also accuse the government of mischief in crafting the SHA contracts, terming the reduced benefits package a slap in the face for many Kenyans who despite the increased contributions, will be forced to make out-of-pocket payments.

The unions insist that members will not sign the contracts until SHA amends the offending clauses.

As the government and key players in the sector engage in a battle of wills, the delivery of healthcare services has been disrupted by the standoff, with opinion divided on whether the transition was rushed or adequate preparation was made.