Kenya Medical Association (KMA) National Governing Council (NGC), the Association’s highest decision-making organ, met at Fairview Hotel for its quarterly meeting to reflect on the state of the Association and the broader healthcare system.
I began by thanking members for their continued commitment to strengthening KMA. The Association has grown in stature and relevance, and this has only been possible through the dedication of its leadership and members. As we approach the forthcoming KMA elections at both national and divisional levels, I urged members to actively participate, not only by voting but also by offering themselves for leadership.
In particular, I emphasized the importance of divisional elections. Strong divisions are the backbone of a strong national Association. Regular Annual General Meetings and competitive elections rejuvenate divisions, attract younger members into leadership, and ensure continuity. A vibrant, representative KMA is essential if we are to remain effective and influential.
Over the past few years, KMA has firmly established itself as the authentic voice of healthcare professionals in Kenya. Many of the challenges currently facing doctors and health facilities stem from systemic issues within the Social Health Authority (SHA), particularly in relation to healthcare financing. While some reforms may be well intentioned, there is growing concern that SHA has taken an overly prescriptive approach to healthcare delivery, attempting to dictate clinical and operational processes in ways that are problematic in practice.
The most urgent and pressing issue, however, remains the persistent non-payment and delayed payment of claims by SHA. This is the elephant in the room. Healthcare services are being delivered, resources are being spent, staff are being paid—or expected to be paid—yet reimbursements are not forthcoming. This situation poses a grave threat to the sustainability of healthcare delivery in Kenya.
Alarmingly, private insurance companies—once the subject of frequent complaints—are now paying claims faster than SHA. In many facilities, private insurers have settled their portion of claims while SHA has not. The direct consequence is that doctors and other healthcare workers are not paid, facilities are pushed into debt, and service provision is compromised.
The structure and processes of SHA claims management are themselves deeply problematic. The claims forms are excessively complex, almost designed for rejection. Many claims are returned for minor technicalities, such as discrepancies in signatures, despite services having been duly provided. While intentions may be in good faith, the system is fundamentally flawed from the outset.
This challenge is further compounded by the role of the Digital Health Authority (DHA). There is increasing evidence that automated and artificial intelligence-driven systems are rejecting claims without adequate human review. SHA has indicated that it cannot pay claims that have been rejected by DHA, creating a disconnect where accountability is blurred, yet healthcare providers bear the financial burden.
The reality is that healthcare providers have already delivered services, incurred costs, and fulfilled their obligations to patients. Rejections on technical grounds after the fact are unjust and unsustainable. KMA must decisively intervene before these failures precipitate a collapse of the health system.
KMA has already initiated engagement, including a courtesy call to the SHA CEO, but it is clear that deeper scrutiny of these processes is required. We must systematically collect data, document experiences from members, and present evidence-based feedback. Learning from how private insurers resolve claims disputes could offer practical solutions that SHA can adopt.
It is also important to be clear: KMA does not condone fraud. Fraudulent practices must be called out and addressed firmly. However, genuine claims should not be rejected under the guise of fraud, nor should the entire profession be guilt-tripped for the actions of a few. One bad actor must not be allowed to punish the ninety-nine who are compliant and ethical.
The human cost of these systemic failures is real and painful. I shared the story of a young doctor struggling under the weight of unemployment, locum instability, and crushing debt—a direct consequence of facilities being unable to pay salaries due to SHA non-payment. It is deeply troubling that highly trained professionals are being driven into financial distress through no fault of their own.
Hospitals—both private and public—are owed tens and hundreds of millions of shillings. These facilities create employment, sustain communities, and anchor the health system. It is untenable for the government to roll out empowerment programmes while failing to pay institutions that generate long-term livelihoods and essential services. This contradiction must be called out.
KMA occupies a unique and strategic position to help resolve this crisis. By aggregating data, unifying the voice of healthcare providers, and engaging policymakers and Parliament, the Association can drive meaningful reform. Discussions with the Parliamentary Committee on Health have already indicated willingness to address legacy debts and financing gaps—but KMA must support this process with evidence and sustained advocacy.
In conclusion, the challenge facing SHA is not just an administrative issue; it is a national healthcare emergency. KMA will continue to speak out, engage constructively, and apply pressure where necessary, until fairness, accountability, and sustainability are restored. Only when healthcare providers are paid can the health system function effectively for the benefit of all Kenyans.
Dr Simon Kigondu
President, Kenya Medical Association