Private Hospitals in the SHA Network

Introduction

The Social Health Authority (SHA), established under the Social Health Insurance Act of 2023, is Kenya’s primary mechanism for advancing Universal Health Coverage (UHC), replacing the National Health Insurance Fund (NHIF) as of October 1, 2024. SHA manages three funds—Primary Health Care Fund (PHCF), Social Health Insurance Fund (SHIF), and Emergency, Chronic, and Critical Illness Fund (ECCF)—to provide equitable healthcare access to over 26 million enrolled Kenyans as of September 18, 2025. Private hospitals play a crucial role in the SHA network, offering specialized services, advanced facilities, and faster care, particularly in urban areas. However, their participation has been marked by challenges, including reimbursement delays and transitional issues. As of September 18, 2025, only about 42% of private hospitals have fully transitioned to the SHA portal, with many providing limited services under the scheme. This article provides a comprehensive overview of private hospitals in the SHA network, including accreditation, key facilities, benefits, challenges, and recent developments, based on official data from the Kenya Medical Practitioners and Dentists Council (KMPDC) and SHA reports.

Background: Private Hospitals and the Transition from NHIF to SHA

Private hospitals in Kenya, numbering over 4,000 (per KMPDC 2025 data), have historically complemented public facilities by offering high-quality, specialized care, but access was limited to those with private insurance or out-of-pocket payments. Under NHIF, private hospitals were contracted for inpatient and outpatient services, but coverage was capped (e.g., KSh 400,000/year inpatient), leading to frequent top-ups and disputes. By 2023, only 26% of Kenyans were enrolled in NHIF, with private hospitals handling 60% of the country’s medical care through the Kenya Healthcare Federation (KHF).

The shift to SHA required private hospitals to re-contract and transition to digital platforms like Afya Yangu for claims submission. As of June 2025, KMPDC licensed over 2,000 private facilities nationwide, with SHA accrediting a subset based on standards for staffing, equipment, and compliance. The Social Health Insurance (General) Regulations, 2024, mandate that private hospitals in the network adhere to SHA tariffs (e.g., KSh 30,000 for cesarean sections) and submit electronic claims within seven days. However, the transition has been uneven, with only 42% of private hospitals fully integrated by October 2024, according to SHA reports. This has led to tensions, including a 14-day go-slow notice issued by the Rural and Urban Private Hospitals Association of Kenya (RUPHA) in September 2025 over unpaid dues.

Despite these hurdles, private hospitals enhance SHA’s network by providing specialized services like oncology and cardiology, which are often limited in public facilities. As of September 18, 2025, SHA has disbursed KSh 551 billion to providers, including private ones, though KSh 43 billion in arrears (including NHIF debts) persists.

Accreditation Process for Private Hospitals

Private hospitals must meet rigorous criteria to join the SHA network, ensuring quality and compliance with UHC goals:

• Licensing by KMPDC: All facilities must be licensed by the Kenya Medical Practitioners and Dentists Council (KMPDC), with over 4,000 private facilities licensed as of June 7, 2024. Levels range from 2 (clinics) to 6 (referral hospitals).
• SHA Contracting: Hospitals apply for e-contracting via sha.go.ke, submitting proof of KMPDC licensing, staffing (e.g., qualified doctors, nurses), equipment (e.g., ICU beds, dialysis machines), and compliance with tariffs. The process, completed for 75% of transitioned private hospitals by October 2024, includes audits for quality standards.
• Facility Levels and Services: Private hospitals are classified by level:
• Level 2-3: Clinics and nursing homes for basic outpatient care (e.g., consultations, minor procedures).
• Level 4-5: Medical centers and hospitals for inpatient care (e.g., surgeries, maternity).
• Level 6: Referral hospitals for specialized services (e.g., oncology, transplants).
• Re-accreditation: Post-NHIF, facilities reapply annually, with SHA suspending non-compliant ones (e.g., due to fraud). As of September 2025, SHA has contracted 180 renal care facilities and 53 cancer centers, many private.

The accreditation ensures private hospitals align with SHA’s tariffs and digital claims system, promoting affordability while maintaining quality.

Key Private Hospitals in the SHA Network

SHA’s network includes prominent private hospitals, particularly in urban areas like Nairobi, Mombasa, and Nakuru. While comprehensive national lists are available on sha.go.ke and KMPDC portals, here are notable examples based on 2025 data:

Nairobi County

Nairobi, with over 4.4 million residents, hosts the highest concentration of private SHA-accredited hospitals. As of April 2025, many offer limited SHA services during transition, but full integration is ongoing:

• Aga Khan University Hospital: A Level 6 facility, fully SHA-accredited, providing oncology, cardiology, and renal care. It has treated over 61 chemotherapy patients under SHA by October 2024.
• MP Shah Hospital: A 217-bed private hospital in Upper Hill, accredited for inpatient/outpatient services. It hosts the 4th Annual Quality Improvement and Patient Safety (QIPS) Symposium 2025, emphasizing SHA compliance.
• Nairobi Hospital: Offers specialized care like transplants and ICU services, with SHA coverage for emergencies and chronic conditions.
• Karen Hospital: Focuses on cardiology and maternity, accredited for SHIF services.
• Other Facilities: Over 500 private clinics and medical centers in Nairobi, including Evans Sunrise Medical Centre (Level 4, 75 beds) and Bliss Medical Centre, accept SHA for basic and specialized care. Many are transitioning, with 75% accessing the SHA system by October 2024.

Other Urban Centers

• Mombasa: Coast General Teaching and Referral Hospital (public-private partnership) and private facilities like Aga Khan Mombasa accept SHA for renal and oncology care.
• Nakuru: Evans Sunrise Medical Centre (75-bed private hospital, established 1998) and Valley Hospital provide SHA services, including outpatient clinics. Nakuru has 504 SHA-licensed private facilities as of June 2025.
• Kiambu County: 504 SHA-licensed private hospitals, including Philgrace Medicare Clinic (Level 2) and Brooklyn Medical Centre (Level 3A), bordering Nairobi.
• Murang’a County: Private hospitals like Neera Dental Centre (Level 3A) and Siloam Hospital Ltd (Level 3B) offer SHA services, with 180 renal and 53 cancer centers nationwide including some here.

Nationwide, KMPDC licensed over 4,000 private facilities for 2025, with SHA accrediting a subset (e.g., 75% transitioned by October 2024). Providers like St. Leonard’s Hospital, St. Francis Community Hospital, and St. Mary’s Mission Hospital Mumias are also part of the network.

Benefits of Private Hospitals in SHA

Private hospitals enhance SHA’s network by:

• Advanced Services: Offering specialized care like chemotherapy (61 patients at KUTRRH under SHA) and dialysis (39 patients), unavailable or limited in public facilities.
• Faster Access: Shorter wait times (same-day appointments vs. 1–2 weeks in public hospitals), crucial in urban areas.
• Quality Standards: Compliance with KMPDC and SHA accreditation ensures high-quality care, with facilities like Aga Khan and MP Shah hosting symposiums on patient safety.
• Equity: SHA tariffs make private care affordable for low-income members, with subsidies for 1.5 million indigent households starting September 2025.
• Network Expansion: Private hospitals fill gaps in public infrastructure, with SHA contracting 180 renal and 53 cancer centers, many private.

By September 2025, private hospitals handled 60% of SHA claims, disbursing KSh 551 billion overall.

Challenges Faced by Private Hospitals in SHA

Despite benefits, private hospitals encounter hurdles:

• Reimbursement Delays: KSh 43 billion in unpaid dues (including KSh 33 billion NHIF arrears) by August 2025 led to a 14-day go-slow notice by RUPHA on September 5, 2025. Facilities like those in Nairobi report 60–90 day lags.
• Low Tariffs: SHA rates (e.g., KSh 28,000/day for ICU vs. market KSh 50,000) are below costs, prompting blanket rejections and financial distress.
• Transition Issues: Only 42% fully transitioned by October 2024, with digital system failures (e.g., eClaims bugs) causing denials. RUPHA highlighted SHA’s “failed fraud detection” and “non-existent Quality Management System” in September 2025.
• Fraud and Suspensions: Incidents like KSh 20 million to ghost facilities led to suspensions, with RUPHA accusing SHA of reinstating non-compliant hospitals via bugs in September 2025.
• Operational Strain: Layoffs (66% of nurses affected) and potential closures due to arrears, as warned by KHF on August 28, 2025.

These issues have prompted demands for transparency and settlement of at least half of SHA’s KSh 43 billion dues.

Recent Developments

• Payment Disbursements: SHA paid KSh 551 billion by July 2025, including KSh 18.2 billion in Q4 2024, but private hospitals remain owed KSh 43 billion.
• BPTAP Reforms: Inaugurated in May 2025, the panel chaired by Prof. Walter Jaoko revised tariffs in February 2025 (Legal Notice 56), addressing some cost concerns.
• Go-Slow Threats: RUPHA’s September 5, 2025, notice demanded NHIF arrears clearance; a meeting on September 10, 2025, urged government action on KSh 76 billion total debts.
• Digital Fixes: SHA addressed eClaims bugs in September 2025, with RUPHA noting reinstated suspended hospitals due to system errors.
• Government Response: Health CS Aden Duale dismissed cartel accusations on September 15, 2025, emphasizing SHA’s anti-fraud measures.

Future Outlook

SHA plans to:

• Clear KSh 43 billion arrears by 2026 through increased funding (PHCF to KSh 15 billion, ECCF to KSh 8 billion).
• Achieve 100% private hospital transition by 2027, with AI-driven claims and tariff adjustments.
• Strengthen partnerships, e.g., with Aga Khan for specialized care.

Conclusion

Private hospitals are integral to SHA’s network, providing advanced services and quality care to over 26 million members, with facilities like Aga Khan, MP Shah, and Evans Sunrise enhancing access. Despite challenges like KSh 43 billion arrears and transition delays, SHA’s accreditation and tariffs promote equity. As of September 18, 2025, reforms by BPTAP and government disbursements signal progress. Patients should verify facilities on sha.go.ke or *147#, ensuring SHA’s private network advances UHC by 2030.

JUA KALI MAISHA MAGIC BONGO SEASON 10 EPISODE 102 YA IJUMAA LEO USIKU 19TH SEPTEMBER 2025 FULL EPISODE