Faith based health service providers under the banner of the Kenya Faith Based Health Services Consortium have issued a 14-day ultimatum to the Government to pay pending SHA, NHIF and MAKL debts totaling to Ksn10 billion. Faith leaders from CHAK, KCCB, MEDS and SUPKEM, which together provide health services through a total of 1,300 health facilities in all 47 counties of Kenya (40 per cent of health care in Kenya) issued the demands during a press conference held at Ufungamano House in Nairobi. 

KENYA FAITH-BASED HEALTH SERVICES CONSORTIUM (KCCB, CHAK, MEDS & SUPKEM)

PRESS STATEMENT ON OUTSTANDING NHIF, SHA & MAKL DEBTS

DATE:  March 06, 2025

VENUE: Ufungamano Christian Students Center, Nairobi

Preamble

The Faith Based Health Service providers comprise all Health facilities under KCCB, CHAK and SUPKEM totaling 1,300 health facilities distributed in all 47 counties in Kenya, but only less than 500 FBO health facilities have been empaneled by SHA, and even less had NHIF contracts.

In addition, the FBOs operate 38 Medical Training Colleges and own MEDS, the pharmaceutical supply chain organization that supports access to quality essential medicines and other Health Products and Technologies countrywide and beyond borders. In all, FBOs contribute approximately 40% of healthcare in the country,

Recognizing that Hospitals received small amounts of payment from SHA in the month of February 2025, and that all Hospitals and MEDS are in serious cash distress; -

Appreciation: H.E The President pledge on March 5^th 2025 to pay those owed less than 10m; However this is grossly inadequate to relief the cashflow distress among the faith-based Hospitals. The ones left unpaid handle the more complicated diseases, specialized surgeries, Critical patients which are costly and life- saving.

The Faith Based health facilities are currently experiencing serious financial distress even as they struggle to continue offering health care services, due to huge outstanding debts owed to them by the defunct NHIF and the current SHA and MAKL. The situation is very dire because we are unable to pay staff salaries, suppliers and cater for other operational expenses necessary for providing the health care services to the deserving communities.

The situation in reference to the above scenario is as follows:

1. NHIF claims

Kes 8 Billion (CHAK 2.4B and KCCB 4.4B) worth of claims remain unpaid under NHIF, some dating back to 2016 to the period of September 2024 when SHA took over NHIF claims:

Recommendation:

We demand, All NHIF pending claims be paid fully by 21^st March 2025.

2. SHA claims

Kes 15Billion (KCCB 1.1B while CHAK is 1.05B) worth of claims remain unpaid under SHA for the 3 months period of October-February 2025. Some of these claims have exceeded the 90-day period.

Recommendation:

We demand, All SHA pending claims be paid by 21^st March 2025 in line with the Social Health Insurance Act 2023.

3. SHA claim stages

The SHA Claims processing has several stages (about 10 stages) which include pre-authorization, under review, under technical review, returned, rejected, approved, loaded to payer, Paid, EFT and then closed. There are roughly 10 stages. This mimics the lengthy bureaucratic stages of the past NHIF HICS system that was intended to be cured under SHA. Clinical review claims can be stagnant for up to 5 months or more based on our experience to-date, and this is an area that requires much improvement.

Recommendation:

Reduce SHA claims processing stages and resolve all claims within 14 days from invoice claim date.

4. SHA payments

Kes 2.18B paid for FBO claims for the period October-December 2024, approximately 50% of all claims made for that period. Most of the remaining claims are held in the other stages mentioned above, especially under clinical review. The current Quarter claims are being paid at approximately 48% based on sample data of January and February 2025 (We have collected data for 217 KCCB facilities as you will see in the attached power-point presentation).

Recommendation:

Add key staff to address the clinical review stage, and/or resolve all cases under this stage within the recommended 14 days.

5. SHA staff capacity

Hospitals are unable to get adequate help from SHA regional offices. They seem not to have been trained or empowered to make any decisions. They always refer all questions/support requests to the system developer who appears to be outside of SHA, unreachable and with all authority.

This is collaborated by media reports quoting the Government Auditor General that the vendor of the 104Billion digital superhighway owns the system, the data, the reports and makes far-reaching decisions.

Recommendation:

SHA staff should be empowered with the necessary capacity and access to manage the SHA system for efficient services to clients and service providers.

6. Reconciliation

SHA system has no reconciliation function for claims inherited from November 2023 to September 2024.

Recommendation:

SHA to provide a transparent portal/dashboard for invoice tracking that can be downloaded for review by Hospitals. NHIF had good reconciliation reports. Provide access to that portal to resolve this portion of the transition reconciliations.

7. PHC and ECCIF

National budget allocated 4Billion (PHC) in July 2024 against a projection of Kes 61Billion; and a 107Billion for ECCIF. Primary health care is virtually collapsed in levels 2-3 and some level 4 facilities that opted to offer services-due to lack of capitation funds. The Quarter of January-March 2025 has not been paid to-date while capitation is expected to be paid upfront.

Recommendation:

Parliament to make adequate budgetary provision and address primary healthcare cash needs promptly. SHA to roll out a workable PHC services payment system, but in the interim use the old capitation model that was simple, predictable and enhanced patient follow-up as they selected a facility every Quarter. Parliament should increase ECCIF funds allocation and gazette appropriate ECCIF tariffs on priority basis.

8. MAKL Claims

The schemes for Teachers, Police and Prisons funded by Government at approximately Kes 20Billion now 10 years on and counting with the same vendor.

FBO Hospitals on MAKL medical scheme have not been paid for periods since July 2024 to date, and for some hospitals, even more months; with a very complicated process of payment, intimidation of Hospitals, unfair business practices and apparent conflict of interest where specific private Hospitals are favored in payments and contract terms.

Recommendation:

The Teachers, Police and Prisons schemes being funded using public funds; be transferred and placed under SHA to strengthen SHA financial sustainability due to economies of scale. This happened for the Civil servant’s medical scheme:

The current MAKL scheme has some bad experiences in cases where the insurer rejects admissions, surgeries and other critical interventions for financial rather than medical reasons.

We demand that all MALK debts paid up by March 21, 2025.

Conclusion

The Faith-based leaders have reached a painful decision, since we cannot afford to take in more debt after numerous engagements with the Ministry of Health, SHA and all necessary Government leaders.

Consequent to the insufficiencies above, there is serious financial distress in FBO Health facilities; This has caused loss of jobs due to redundancies, unpaid vendors for medications and other commodities, threats of collapse and closure of Health facilities, Court cases by creditors, expensive bank loans, listing in CRB (credit reference bureaus) attachment of assets by creditors and inability to get further credit facilities.

Thus, the Kenya Faith Based Health Services Providers are issuing a 14-days ultimatum demanding for immediate payment of outstanding NHIF, SHA & MAKL debts totaling to Ksh.10 billion plus (NHF 6.8Billion, SHA 2.2Billlion and 1Billion for MAKL) to FBO health facilities failure to which, we will be forced to suspend offering services to beneficiaries of the said scheme and offer the services to them on cash payment basis.

Statement from Religious Leaders of Kenya Faith Based Health Services Providers