SHA transition from defunct NHIF face stagnation, RUPHA report show

System challenges and operational hiccups dogging the Social Health Authority (SHA) has occasioned transition stagnation from the defunct National Hospital Insurance Fund (NHIF) to SHA, a new report released by the Rural and Urban Private Hospitals Association of Kenya (Rupha) monthly publication shows.

The report that sought to evaluate progress and challenges in the transition from NHIF to SHA paints a grim picture of the status of the healthcare system in the country whose inefficiencies has subjected patients to untold suffering, agony and potentially exposing the terminally ill to the risk of unfortunate fate, death.

Majorly, Rupha report says that rampant technical and financial challenges and incessant portal downtime have made hospitals incapable of operating optimally.

“The findings reveal stagnation in the SHA transition, with persistent technical and financial challenges crippling healthcare facilities’ ability to operate effectively. The overall transition score remains at 46 per cent, unchanged from November.” The report shows in part.

“Challenges such as frequent portal downtimes, delayed payments and inadequate training on the system hinder providers and patients, calling for urgent interventions.” The report says.

More than 78 per cent of respondents reported challenges like downtimes, delays with One-Time Passwords and errors in pre-authorisation requests.

“These have significantly impacted services, as hospitals struggle to access and process claims. Only 22 per cent of hospitals rated the portal’s functionality as satisfactory – a sharp decline from 45 per cent in November,” the report adds.

It also notes that financial strain continues to affect healthcare providers, with 39 per cent saying they did not receive any payments in November.

Those that got paid faced reduced capitation amounts, with the average fall standing at 23 per cent.

Further, the survey revealed that three out of 10 hospitals have challenges accessing the SHA system, with some being locked out or having approved credentials that fail to work which shows a 46 per cent transition score to the system.

The Rupha report also notes key metrics such as portal functionality, financial stability and patient verification, which continue to show systemic inefficiencies.

According to the survey, the proportion of hospitals experiencing system access challenges has risen from 17 per cent in November to 29.3 this month.

Of these, some 17 per cent reported being locked out of the system, while 12.2 per cent cited problems with non-functional credentials.

“Providers are grappling with acute financial distress, as delayed and insufficient payments from SHA undermine their ability to maintain operations and pay staff. The lack of transparency in payments is exacerbating the issue.” The report says.

However, more than 90 per cent of private hospitals report having access to the SHA portal, used to onboard individuals to the Social Health Insurance Fund (SHIF).

“There has been a marginal drop in the overall score, largely due to the issues identified. Outpatient services have been critically affected, with our score indicating a positive sentiment of only 32 per cent – or 1.6 out of 5 – regarding SHA outpatient services.” Rupha chairperson Brian Lishenga said.

“This relates to capitation for patients seeking outpatient care. Maternity services stand out, with a sentiment of about 2.75 out of 5 – approximately 55 per cent positive. Surgical services have a slightly better rating at 50 per cent. In general, patient perception remains 67 per cent negative.”

The December report surveyed 219 hospitals through phone interviews and online questionnaires. Respondents included a mix of private and public Level Two to Level Five hospitals.