The current Social Health Authority contracting process raises serious questions about cost, bureaucracy and the regulatory burden being placed on healthcare providers.
The Council of Governors-Kenya has now raised substantial objections to applying the same contracting framework to county public facilities. Its position is essentially that county facilities are service points of county governments, not independent private businesses, and therefore several of SHA’s requirements do not fit their legal and governance structure.
Among the issues raised are requirements relating to KRA PINs, NSSF compliance, data-protection registration, audited financial statements, licences, domain-based emails and the authority of individual facility managers to execute contracts. The Council has asked SHA to defer the new contracting framework for public facilities while these matters are resolved.
That leaves private and faith-based facilities in a very different position.
My practical advice to private and faith-based facilities
Comply with the contracting requirements, however burdensome they may be, while continuing to challenge requirements that are unlawful, duplicative or unreasonable.
Do not assume that the Council of Governors’ intervention will automatically protect private and faith-based facilities. The COG is negotiating primarily on behalf of county governments and county-owned facilities. Political negotiations may ultimately resolve the difficulties facing public facilities while private providers remain subject to the existing requirements.
And for a private or faith-based health facility, failure to secure an SHA contract can become an existential threat.
This is particularly concerning in an economy where households are already under considerable financial pressure. When patients have limited capacity to pay out of pocket, exclusion from a major public purchasing mechanism can severely affect patient access, cash flow and ultimately the survival of a facility.
There is also the longstanding concern around Single Business Permit requirements. Providers should carefully interrogate requirements for so-called “unified business permits” where these effectively incorporate fees that healthcare facilities have previously contested or claimed exemption from. Administrative repackaging should not settle an underlying legal question.
As the deadline approaches, concentrate on what you can control
Get your statutory and mandatory remittances in order. Prepare the required financial statements. Check every licence and compliance document. Most importantly, ensure that the legal name on the KMPDC licence corresponds exactly with the name on the bank account and the details submitted to SHA. In this environment, even apparently minor administrative discrepancies can have major consequences.
Submit within the stipulated timelines and preserve copies and evidence of every submission.
At the same time, providers should continue demanding answers to a fundamental question: what obligations does SHA itself owe providers?
A contracting relationship cannot sustainably operate as a one-way compliance exercise. If a healthcare provider has delivered an authorised and verified service, payment should not become indefinitely discretionary. This is particularly important while facilities continue carrying outstanding NHIF legacy claims and unpaid or delayed SHA claims.
The Council of Governors itself makes an important point in its letter: verified claims for services already rendered should be treated as debts, with defined payment timelines rather than being left indefinitely dependent on future appropriations.
That principle should matter to every healthcare provider — public, private and faith-based.
For now, however, providers have to manage the immediate operational risk. Do what is necessary to remain eligible for contracting while professional associations, facility owners and other stakeholders continue pursuing the larger legal and policy questions.
Comply today. Document everything. Challenge what requires challenging through the appropriate processes.
Running a health facility in Kenya increasingly feels like a PhD in medicine, law, taxation, regulation, procurement and survival — all at the same time.
As the SHA contracting deadline approaches, I wish every healthcare facility rushing to complete this process success.
And today, perhaps hug a health facility owner. They probably need it.
