upepo
Elder Lister
It’s not that SHA itself is “good” or “bad.” It’s about how the money moves after SHA pays.
Why Private Hospitals are "celebrating" SHA
1. 90/10 and Direct Payments work for them
Private hospitals get 90% of the SHA claim paid directly to their account. They can pay suppliers, staff, and buy drugs immediately. Fast cash = functioning hospital.
2. No legacy debts
Most private facilities weren’t owed billions by NHIF. They started SHA with a clean slate.
3. Selective services
They can choose to offer only profitable, well-paying SHA packages. If a service loses money, they just don’t offer it.
For them SHA = predictable revenue.
Why Public Hospitals feel "dead"
1. 90/10 + Direct Payment to KEMSA/Vendors first
Before the public facility sees any money, 90% goes straight to KEMSA and other vendors. The hospital gets 10% to run the whole facility.
That 10% must pay: electricity, water, food for patients, cleaning, fuel, casual staff, maintenance. It’s impossible.
2. No working capital
Public hospitals used to use NHIF/SHA money as a revolving fund to buy drugs, food, and pay casuals while waiting for Treasury. With direct payment, that buffer is gone.
3. Chronic care is unfunded
Kidney dialysis, cancer chemo, cardiac care, MRI servicing cost millions. The SHA package rate + 10% left behind can’t cover reagents, maintenance contracts for C-Arm, MRI, lab equipment. So machines sit idle.
4. Strike + environment
When there’s no money for allowances, overtime, or even gloves and food, staff down tools. No staff + no supplies + no cleaning = exactly what you described.
So public hospitals are doing the heaviest work — emergencies, wards, chronic patients, indigents — but with the smallest share of money.
The Core Problem
Same SHA card, two different financial models.
Private: 90% cash in hand, choose your patients.
Public: 10% cash in hand, must take everyone, and pay for everything else.
That’s why one is celebrating and the other is collapsing.
To make this fair for public facilities and patients:
1. Review the 90/10 model for Level 4-6 Public Hospitals
Move to at least 60/40 revenue share to Hospitals and vendors respectively and allow facilities to retain money for food, fuel, maintenance, medicine, medical supplies and casuals.
Direct pay to KEMSA should be quarterly, not per claim.
2. Ring-fence a Chronic Disease & Equipment Fund
A separate SHA pool to pay directly for dialysis, cancer, cardiac, and for MRI/C-Arm service contracts. Don’t force wards to subsidize machines.
3. Emergency Operations Grant
Monthly capitation from SHA to public hospitals for utilities, food, cleaning — regardless of claims. So wards don’t close while we wait for verification.
Closing line:
"Mr. President, if we want UHC, the hospitals that serve 70% of Kenyans cannot be left with 10% of the money. Let’s fix the flow of funds, and both patients and public hospitals will start celebrating too."