Kenya’s Hospitals on the Brink: How the Social Health Authority is Failing Patients

Editor’s note: In this powerful piece, Maroa Rioba a clinical doctor and Advocate of the High Court of Kenya exposes how political maneuvering within the Social Health Authority is crippling hospitals across the country. Drawing on legal rulings, case studies, and lived realities in Kenya’s health facilities, Rioba calls on the state to end delay tactics and prioritize healthcare financing over political theatrics.

Hospitals across Kenya are on their knees. Not because they failed to serve patients, but because the very government mandated to protect healthcare is strangling it for political convenience.

For months, the Social Health Authority (SHA) has failed to pay hospitals for services already rendered, some claims dating back to the defunct NHIF era. Facilities are running out of drugs. Staff salaries are delayed. Some hospitals are shutting down wards. A case in point is the St Mary’s Hospital which closed early last month, after accumulating Ksh180 million in unpaid claims from government health schemes.

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And yet, amid this crisis, we are treated to televised political pageantry, millions of shillings pledged to footballers, lavish county tours like in Homa Bay, and endless campaign-style promises. Money flows easily when it suits political optics, but dries up when it comes to paying hospitals that keep Kenyans alive.

The High Court delivered a judgment that should end the excuses. It quashed CS Aden Duale’s decision to form a committee to “verify” pending bills owed to hospitals by the defunct NHIF. The court was clear:

• SHA inherited all liabilities of the NHIF and must pay.
• The so-called verification committee would unlawfully take over the constitutional role of the Auditor-General, making it unconstitutional.
• The delays are not administrative prudence. They are illegality disguised as process.

This ruling is not just a legal win for hospitals, it is a moral indictment of a government that has chosen delay tactics over human lives.

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The Broken Promise of SHA

SHA promised hospitals two payments every month. Instead:

• Up to 95% of claims are rejected without explanation.
• Claims are not returned for correction, they simply vanish into the system.
• Selective payouts: surgical claims processed, general inpatient claims ignored.
• Hospitals live in fear of sudden portal deactivations, accused of fraud without proof or due process.

Small and rural hospitals, the real backbone of Kenya’s healthcare are the worst hit. They have no political muscle, no reserves, and no choice but to cut back services.

Politicised Parastatal

The CS for Health has turned SHA into a political tool rather than a neutral public health financier. His focus on SHA’s operations has reduced the rest of the ministry to an afterthought. SHA is no longer a parastatal. It is a political machine, selectively paying, selectively punishing, and selectively rewarding.

Meanwhile, the President has been busy trying to win back the Gen Z vote ahead of 2027, dangling multi-million-shilling sports bonuses, promising KSh 1 million to each player for every Harambee Stars win, KSh 600,000 for every draw, and KSh 600 million for a CHAN victory. Sports development is noble. But not when hospitals are collapsing from unpaid debts.

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The law is clear, the excuses are not

This crisis is more than mismanagement. It is a violation of the Constitution:

• Article 43, the right to the highest attainable standard of health.
• Article 47, the right to fair administrative action.
• Fair Administrative Action Act, Demands reasons for all adverse decisions.
• Public Finance Management Act, requires lawful and accountable use of public funds.

By rejecting claims without explanation and withholding payments, SHA is breaching all these principles.

The cost of playing politics with health

Every delayed payment means:

• A mother in rural Turkana delivering without a sterile environment.
• A child in Kisii dying of pneumonia because oxygen cylinders are empty.
• A diabetic patient in Njoro going blind because insulin is out of stock.

We cannot fund football dreams while killing hospital wards.

The way forward

The High Court has spoken. Now, the government must act:

• Settle all pending hospital bills immediately, including those inherited from NHIF.
• Stop politicizing SHA and return it to its intended neutral role.
• Guarantee predictable, transparent payments to all facilities, big or small.
• Audit payments through the Auditor-General, not politically appointed committees.

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Healthcare is not a campaign tool. It is the difference between life and death. Until Kenya fixes its health financing, no amount of stadium cheering will drown out the cries from our empty hospital corridors.

The author is Maroa Rioba, a practicing medical doctor and an Advocate of the High Court of Kenya, passionate about health rights and constitutional accountability.

Views expressed in this article are solely those of the author and do not represent the position of TUKO.co.ke.

Source: TUKO.co.ke