Pressure is building on the Social Health Authority after MPs issued a three-month window to clear more than Sh10 billion in unpaid NHIF claims that hospitals say have stalled operations and weakened their finances.
The latest findings by the National Assembly Committee on Health show that one year after SHA took over from NHIF, many hospitals have continued to wait for funds that were already approved but never paid.
The report paints a picture of facilities struggling to keep up with growing expenses while expecting money that has remained pending for months.
Mbagathi Hospital is yet to receive Sh279.5 million, while St Elizabeth still awaits Sh2.6 million. Matata Nursing Home is owed Sh53 million, Rachuonyo County Hospital Sh22.4 million, Nyandiwa Level 4 Hospital Sh5.6 million, and St Mary’s in Mumias Sh143 million.
Other hospitals named include Nyeri County Referral Hospital with Sh156.6 million unpaid, Sipili Maternity and Nursing Home with Sh9 million, PCEA Tumutumu with Sh89.8 million, and Nyahururu County Referral Hospital with Sh36.7 million still pending.
The committee, chaired by Seme MP James Nyikal, said the cash flow challenges in these hospitals stem from continued delays and inconsistent disbursements by SHA.
"A substantial backlog of arrears inherited from the defunct NHIF remains unresolved. Approved but unpaid claims continue to accumulate across facilities, further straining the financial stability of hospitals," reads the report.
The report also flagged problems arising from processing mistakes that have affected hospital accounts. One such case involved Nyeri County Referral Hospital, which lost more than Sh16 million to a nearby private facility due to errors, with the money never recovered.
Faced with this growing backlog, the committee has asked the National Treasury to trigger Article 223 of the Constitution so that the government can release the Sh10 billion without waiting for parliamentary approval.
"The National Treasury should invoke Article 223 of the constitution to facilitate the settlement of outstanding NHIF debts of up to Sh10 billion, thereby ensuring the financial stability of health facilities and restoring confidence in the transition to the Social Health Authority," reads the report.
Article 223 allows the Treasury to withdraw funds from the Consolidated Fund before seeking approval, provided Parliament approves the spending within two months.
The committee also directed SHA’s CEO to act immediately to prevent service interruptions caused by the delayed reimbursements.
"As verification of the defunct NHIF debt continues, the Chief Executive Officer of SHA should immediately disburse all pending SHA reimbursements to prevent service disruptions," reads the report.
Hospitals told the committee that many of their claims had been rejected even when they had supplied full documentation.
"Hospitals reported the absence of a clear and transparent mechanism for claim resubmission, with feedback on rejected claims often delayed well beyond the 90-day statutory period," reads the report.
To correct this, the lawmakers ordered SHA to observe the 90-day limit for settling claims and to provide standardised remittance statements showing all paid, pending, and rejected claims together with the explanations for each decision.
"Rejected claims shall include clear justification and allow for resubmission through the digital portal. The CEO is to submit a compliance and implementation report, including a comprehensive financial statement of all SHA revenues and expenditures within three months," reads the report.
The committee further insisted on the return of human checking for claims flagged by AI, giving SHA 45 days to restore the measure.
"Where fraud or non-compliance is detected, the CEO of SHA should initiate investigations and ensure that any identified fraud is prosecuted at the individual level while ensuring that no health facility is closed unless care continuity is guaranteed," the Committee said.
