SHA under fire over NHIF debt, denied healthcare services

Acting SHA CEO Dr. Robert Ingasira was pressed to explain the financial obligations inherited from the now-defunct NHIF, particularly funds allegedly owed to service providers. 

Lawmakers also raised concerns about NHIF settling Work Injury Benefits Act (WIBA) claims without a formal contract, based on verbal directives from the then Treasury Cabinet Secretary.

Dr. Ingasira revealed that the defunct NHIF owed Ksh 30.9 billion, with outstanding premiums amounting to Ksh 25 billion.

 "Various state departments owe us Ksh 25 billion. SHA has been engaging these departments to facilitate payment so that we can settle service provider claims," he stated.

However, committee chair Dr. Robert Pukose questioned why SHA had yet to clear the pending bills left behind by NHIF. 

Lawmakers were particularly critical of NHIF’s payments for WIBA claims without formal agreements.

"How will you pay the claims if there's no formal contract? Isn't that fraudulent?" Dr. Pukose demanded.

Hon. Maingi further challenged the payments, asking, "If you say there was no contract, where was the money you were paying?"

Dr. James Nyikal expressed skepticism over NHIF’s involvement in WIBA, stating, 

"What does health insurance have to do with compensation? WIBA is not related to NHIF or healthcare at all. Workman’s compensation involves direct payments, not medical treatment. That is not SHA’s mandate."

Defending the payments, Dr. Ingasira clarified, "There was formal communication from the then Treasury CS requesting NHIF to receive and pay all claims from civil servants under WIBA."

Beyond the NHIF financial woes, legislators also questioned SHA over claims denials and refusal to authorize medical services, despite Parliament allocating sufficient resources to the Primary Health Care Fund. 

Dr. Pukose pointed out the discrepancy, saying, "Parliament has allocated Ksh 4 billion, yet you have spent only Ksh 375 million. This means you have more funds available, and people should be receiving services. Even in supplementary budgets, we won’t allocate more funds because you haven’t even exhausted what you have."

MP Mathenge criticized SHA’s approach, adding, "You are making healthcare facilities suffer. Why should SHA continue with this arrangement?"

Acknowledging the concerns, Dr. Ingasira assured the committee that a review of tariffs and benefits was underway. 

"I agree with you, Honorable Members. These tariffs are insufficient, and we are undertaking a review of primary healthcare benefits. We will subject the changes to the Tariffs and Benefits Committee," he said.

The rollout of SHA has faced public backlash over systemic inefficiencies and rising out-of-pocket healthcare expenses. 

This prompted the Departmental Committee on Health to demand answers on the ongoing challenges.

SHA attributed the setbacks to initial implementation difficulties but pledged to streamline services in the coming days.