Faith-based hospitals in Kenya warn unpaid Social Health Authority bills threaten care for most vulnerable patients

Faith-based hospitals in Kenya say delayed reimbursements from the new Social Health Authority (SHA) are crippling operations and threatening patient care, officials with the Christian Health Association of Kenya told Christian Daily International.

“We are owed about 4 billion Kenya shillings ($30m) within the faith-based fraternity,” said Dr. Chris Wekesa Barasa, general secretary and chief executive officer of Christian Health Association of Kenya. “Some facilities rely on (SHA for) 90 percent of their income.” 

Barasa says the problem has historic roots dating to the transition from the National Hospital Insurance Fund to the Social Health Authority (SHA), and that payment delays have worsened since the new body began operations. The Social Health Insurance Act and accompanying regulations created SHA to consolidate Kenya’s path to universal health coverage, but the rollout has been rocky. 

“The transition from NHIF to SHA is complete, but the new system faces early operational and financial challenges,” a recent report noted, pointing to slow claim payments and system failures. 

Multiple news reports and provider statements show the scale of unpaid claims has been large and growing. Industry groups and private hospitals have reported tens of billions of shillings in outstanding claims, and some estimates put aggregated unpaid SHA claims far higher than what individual faith facilities report. 

The Ministry of Health and the cabinet secretary have publicly acknowledged payment problems and pledged corrective action. In a ministry statement, Health Cabinet Secretary Aden Duale defended the SHA reform as part of a drive to reach universal health coverage while promising steps to stabilize finances. 

In late 2025 the government moved to clear some legacy NHIF arrears and to allocate supplementary funds for facilities with smaller outstanding claims, a sign of political pressure to address liquidity problems among providers. 

Barasa described immediate operational impacts at CHAK member hospitals: delayed supplier payments, strained payrolls, and cash-flow shortages that limit the ability to buy medicines and keep essential services running. “We are on the verge of crippling some functions because some facilities rely on 90 percent of their revenue on SHA,” he said. 

CHAK, which represents hundreds of mission hospitals, medical training colleges and clinics across Kenya, has pressed for a predictable claims timetable and faster reimbursements so facilities can plan and keep patients from facing out-of-pocket fees. The association has joined other faith and private sector groups in urging the government to clear arrears and ensure SHA payment schedules are reliable. 

Observers say that the SHA troubles are both administrative and fiscal. Early reporting and analyst shortfall at SHA and teething problems with claims processing, digital systems and provider contracting. One analysis warned that rapid enrollment under SHA masked deeper issues: high provider distress and low rates of claims paid. 

That shortfall has prompted parliamentary scrutiny and calls for SHA to clear specific pending NHIF-era bills. Members of Parliament and religious leaders have pushed the ministry to settle legacy debts, warning that prolonged delays could force some hospitals to scale down operations or, in the worst case, close. 

While demanding faster payments, CHAK is also pursuing resilience measures. Barasa stressed the need for efficiency and diversified revenue streams as a buffer against payment uncertainty. 

“We are engaging our facilities to come up with solutions that are home-grown,” he said, pointing to procurement efficiencies, solar financing and county-led service models aimed at reducing operating costs and improving sustainability. 

CHAK has recommended clearer contracting terms, predictable reimbursement timetables, and phased payments to prevent service interruptions while SHA stabilizes. 

The group also urged that any punitive quality control measures in new regulations be balanced with financial support for facilities that need to upgrade to meet standards. 

Barasa was alluding to the Quality Healthcare and Patient Safety Bill, 2025, which was introduced to bring tighter controls to the healthcare sector. This proposed law would introduce national quality standards and stricter enforcement mechanisms for health facilities.

Kenya’s SHA reform was designed as a pillar for universal health coverage, but a series of systematic mishaps including unpaid claims, budgeting and provider engagement has left many providers and patients in a limbo. 

If unpaid claims persist, providers warn of reduced access to care, increased out-of-pocket payments for patients, and financial distress in hospitals that have traditionally served the poorest and most remote communities. 

“We have a social contract with the people of Kenya to deliver universal health coverage,” Barasa said, while also acknowledging the need to “cleanse the system and build a transparent, accountable, and equitable healthcare system.” 

For CHAK members, the immediate demand is simple and urgent: timely payment of claims owed under the old and new schemes so hospitals can continue to operate. The association urges system fixes that match the scale of the reform, from reliable funding flows and better digital claims processing to realistic timelines and support for quality improvements.

“If you’re not giving us money to be able to improve our quality of care, but then you impose punitive measures, some facilities will not manage,” Barasa warned. “We need predictable payments, and we need partners to recognize the role faith facilities play in keeping health services accessible.”