Why Select Hospitals Pocketed Millions from SHA

Public and private hospitals across parts of the Central region have received substantial payouts from the Social Health Authority (SHA) due to timely compliance with established regulations.

The National Assembly Departmental Committee on Health’s fact-finding mission revealed that the SHA has disbursed millions of shillings in claims to compliant hospitals.

A section of Committee members, led by Mwea Member of Parliament (MP) Mary Maingi and Samburu County MP Pauline Lenguris, began a fact-finding tour of selected hospitals to assess both the benefits and challenges of the scheme.

At Nyahururu County Referral Hospital, the lawmakers established that the facility had implemented robust compliance measures, enabling it to secure significant funding from SHA.

We can confirm that SHA is working at Nyahururu Referral Hospital. We were impressed by the measures put in place by the management to ensure timely compliance.

Lenguris stated that the Committee found SHA desks in every department where patients seek services.

“Staff are also actively assisting unregistered patients to enrol in the scheme,” she added.

Amounts Received from SHA

As a result of these initiatives, Nyahururu County Referral Hospital has received more than Ksh170 million in claims as of August this year, representing 74 per cent of its submitted claims.

According to the hospital’s CEO, Dr Lawrence Kamande, the facility received Ksh6.5 million from the Primary Health Care Fund and Ksh170.3 million from the Social Health Insurance Fund.

However, the hospital still owes Ksh61.4 million in pending SHA claims, in addition to Ksh36.7 million in arrears from the now-defunct National Hospital Insurance Fund (NHIF).

Also Read: Has the SHA System Been Hacked?

The Committee also visited Sipili Maternity Nursing Home and Nasili Medical Facility, both private institutions deemed fully SHA-compliant.

The Administrator of Nasili Maternity Nursing Home, Daniel Kariru, informed the legislators that the facility had received 74 per cent of its cumulative claims to date.

“The latest claim we received amounted to Ksh18.9 million against the Ksh25 million submitted,” he explained.

The Committee is scheduled to continue its oversight mission with a similar tour of selected hospitals in Nyeri County. Nyeri County.

Also Read: 1.5 Million Kenyans to Enjoy Full SHA Services Free with Immediate Effect

Homabay County Tour

The Committee has launched a countrywide fact-finding mission into the troubled SHA system, amid mounting complaints over delayed claims, rejected payments, and allegations of fraud.

The committee, chaired by Seme MP Dr. James Nyikal, also visited Homa Bay.

They toured several health facilities, including St. Elizabeth Swindon Hospital, Matata Nursing Hospital, the proposed Nyandiwa Health Centre, Rachuonyo Level 4 Hospital in Kasipul Constituency, and Nyandiwa Level 4 Hospital in Suba South.

Identified Challenges

Among the challenges identified was that while members who have paid their premiums can access services, those who have only registered without making payments are locked out.

Outpatient funds have been allocated, but the system is still performing poorly, while emergency funds released by the government are not being processed effectively.

Dr. Nyikal noted that the transition from the defunct NHIF to SHA had created confusion, leaving both hospitals and patients struggling to access services.

We have found that the systems for registration and claims exist, but they have not been well understood. Some claims are delayed; others are returned or rejected. The challenge is worsened by the fact that SHA does not yet have local offices only NHIF branches remain making follow-up nearly impossible.

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