Nyeri hospital at risk of closure over SHA funding delays

Provision of health services at the Tumutumu Mission Hospital in Nyeri may soon grind to a halt following slow disbursement of funds by the Social Health Authority (SHA).

 The 115-year-old Level 5 hospital which is affiliated to the Presbyterian Church of East Africa (PCEA), needs more than Sh200 million owed by the Ministry of Health paid up to facilitate its services.

 Part of the Sh247 million claims comprise of Sh148 million worth of claims that were yet to be settled by SHA while the remaining Sh89 million are arrears inherited from the now defunct National Health Insurance Fund.

 So dire is the cash crunch at the facility that the hospital has defaulted in remitting statutory deductions of its more than 400 employees.

 The hospital has now resorted to using bank loans and donor money to pay salaries to its staff and handling its critical core mandate of providing health care to the public.

 “We have gone through a financial paralysis for quite some time. We provide services to the tune of Sh35 million and sometimes Sh40 million a month but the reimbursement we get from SHA is both intermittent and inadequate. Out of the Sh140 million we were expecting cumulatively, the hospital was only reimbursed Sh4 million. This one created a financial gap which almost brought the hospital to its deathbed,” said the hospital’s chief executive officer Kinyua Mukindia on the side-lines of a visit to the facility by the National Assembly’s Committee on Health.

 He said owing to its dire financial situation which has seen it deplete all the available funds at its disposal, the continued provision of quality and quantitative health care may not be possible beyond September 10 in the absence of intervention from the SHA.

 The CEO therefore appealed to the government to release the funds as a matter of urgency just as the architecture of SHA was crafted.

 “For the first time in the history of this hospital, we have not been able to remit staff deductions for four months not by design, not that we wanted to be that way, but because SHA has not been resourcing the hospital adequately. For the first time in the 115-year history of this hospital, we are now depending on government overdrafts and loans from financial institutions so that we can remain afloat. I believe this was not what was intended,” he told the parliamentary committee led by Nyeri Town MP Duncan Mathenge and his Samburu counterpart Pauline Lenguris.

 The visit unearthed a series of challenges with the SHA system which is a month shy of its first-year anniversary since it was rolled out in 2024.

 For instance, the committee discovered that a good number of claims had been rejected unilaterally by the SHA system.

 The facility also lacked a feedback mechanism to engage SHA either physically or online, on the steps to be taken to amend the rejected claims.

 Additionally, the facility was unable to ascertain the status on the processing of already logged claims leaving them in the dark on whether or not they would be reimbursed their money by SHA.

 “There are issues in how the systems are processing the claims from the time the patient enters the hospital, to the time they leave the hospital and the time the claims are forwarded to SHA through the system and the interaction between the hospital and SHA up to the point where the payments are made. The payments are not timely; they are lagging behind by about 40-50 per cent behind schedule,” Mathenge said.

 “In this hospital, we can authoritatively say that from our interaction with them, we have not been able to come across any element of fraud. It is a question of either documents that have been uploaded and are apparently not visible by the SHA system or an issue of request for the provision of additional documents yet the system is not allowing for attachment of the additional document to be added or resubmitted,” added the legislator.

 Mathenge attributed the delays to inefficiencies by SHA to reimburse the facilities in good time despite the hospitals providing services.

 He said the committee would be convening a meeting with the Ministry of Health and SHA to streamline bottlenecks in the reimbursement process that are now threatening to cripple the entire healthcare system.

 “The question of the flow of finances through the system is a major thing that is being acknowledged by both sides. On one hand, SHA contributors are paying the premiums, and then they come and receive services. Hospitals discharge the patients having received the services but the money takes quite a while to come to the hospitals from the authority. We have scheduled a meeting on September 9 with both SHA and the ministry and the fact finding will help enhance and occasion a more meaningful and a deeper conversation about what needs to be done,” Mathenge said.

 In order to improve the implementation of SHA, the legislator said the committee would table a raft of recommendations to the Health ministry some which include critical assessment of the adequacy of the current health budget in sustaining Universal Health Coverage.

 Mathenge said the committee would also be proposing an evaluation of the health SHA premiums where possible as a way of ensuring healthcare is sustainably funded.

 “From the performance of the roll out of SHA since October last year up to this point, there are indicators that the financial flows are sustainable and if they are not, then we will need to rethink either in terms of increasing provisions in the budget to support Universal Health Coverage or revise the contributions in one way or another so that by the time services are being rendered, at the end of the contractual 90 days credit period, ideally the full amount due to the service provider should be paid,” Mathenge said.