By The Weekly Vision Reporter
The Social Health Authority (SHA) has announced the remittance of Ksh27.91 billion to health facilities under county governments, portraying the figure as evidence that its claims settlement system is working efficiently. However, a closer examination of the Authority’s own data reveals that billions of shillings in claims remain unpaid, under review or rejected, raising fresh questions about the financial sustainability of public health facilities across the country.
In a statement issued on 2nd July 2026, SHA said it had received claims worth Ksh40.91 billion from 8,349 county government health facilities by 30th June 2026. Whilst Ksh27.91 billion has been paid, the remaining Ksh13 billion has yet to reach health facilities. According to the Authority, Ksh6.96 billion is still under review; Ksh1.97 billion has been returned to hospitals for correction or completion; Ksh646.2 million is awaiting supporting documents; and Ksh3.43 billion has been rejected outright for failing to meet benefit, contractual, or regulatory requirements.
Although SHA says it has settled approximately 80 per cent of claims that have completed adjudication, that figure does not mean 80 per cent of all claims submitted by hospitals have been paid. Instead, a significant portion of the money claimed by public health facilities remains tied up in various stages of processing, a distinction the Authority’s statement did not make plainly clear.
SHA attributed the pending claims to mandatory verification processes, including confirmation of patient eligibility, benefit entitlement, approved tariffs, clinical information and supporting documentation.
The figures are nonetheless likely to fuel concerns among county governments and healthcare providers, who have repeatedly complained about delayed reimbursements and the mounting financial pressure facing public hospitals. Delayed claim payments can leave facilities struggling to procure medicines, pay suppliers and sustain essential health services for patients who depend on them.
The Ksh3.43 billion in rejected claims further highlights the scale of disputes between healthcare providers and SHA over compliance with claims requirements. Meanwhile, the return of Ksh1.97 billion in claims for correction suggests that many facilities continue to encounter difficulties navigating the Authority’s submissions process, a problem that SHA has itself acknowledged.
The Authority said it has been conducting nationwide claims clinics to train healthcare providers on proper coding, documentation and the application of approved tariffs, in an effort to reduce errors and accelerate payments. SHA maintained that the training has led to an increase in clean claims and a reduction in the number of claims being returned or rejected, adding that it will continue working with county governments and healthcare providers to improve claims management.
SHA’s statement identified the counties receiving the largest payouts, driven by high claim volumes. Nakuru led the list with Ksh1.93 billion, followed by Nairobi (Ksh1.57 billion), Homa Bay (Ksh1.54 billion), Mombasa (Ksh1.41 billion) and Kiambu (Ksh1.27 billion).
Even so, the figures are unlikely to settle the broader debate over SHA’s effectiveness. Hospitals and county governments continue to push for faster reimbursements and greater transparency in claim processing. The true measure of the Authority’s performance, observers argue, will not be the value of payments announced in press statements, but whether health facilities receive their reimbursements promptly enough to provide uninterrupted patient care to the Kenyans they serve.
