SHA building/FILE
The Social Health Authority (SHA) has announced a new accountability measure that will link part of payments to contracted primary healthcare facilities to the proportion of prescribed medicines they dispense to patients.
In a public notice issued on Tuesday, July 21, 2026, SHA Chief Executive Officer Mercy Mwangangi said the move is aimed at addressing gaps identified in the dispensing of medicines under the Primary Healthcare (PHC) Fund.
SHA said the PHC benefit package covers the "complete episode of care" in line with the Ministry of Health treatment guidelines. This includes consultation, diagnosis, clinically indicated investigations, treatment and prescribed medicines.
However, the authority said it had established that some contracted facilities were not providing the full package of care, leaving some beneficiaries without all the medicines covered under the scheme.
"SHA has identified gaps in medicine dispensing in some facilities, resulting in beneficiaries receiving only part of the care covered under the PHC package," the notice states.
To improve accountability, the authority said it will monitor every contracted facility's medicine-dispensing rate through the Digital Health Agency platform and reimburse facilities based on the level of service they provide.
Under the new framework, SHA will first determine each facility's monthly reimbursable entitlement using the existing weighted global budget capitation model.
The authority said the pharmacy component has been set as a fixed share of the total resource allocation, while the remaining amount will cater for consultations, staff time, consumables, diagnostics, overheads and other service delivery costs.
SHA will then calculate a facility's dispensing rate by comparing the number of medicines dispensed against those prescribed and recorded in the approved digital system.
The dispensing rate will only be applied to the pharmacy component of the reimbursement.
For example, a facility that dispenses 100 per cent of prescribed medicines will receive the full medicine payment. A facility with an 80 per cent dispensing rate will receive 80 per cent of the pharmacy payment, while the remaining 20 per cent will be deducted.
SHA clarified that the non-medicine portion of the reimbursement will not be affected by the dispensing rate.
According to the authority, the payment model is intended to reward facilities that consistently provide patients with all prescribed medicines while ensuring reimbursements reflect the actual services delivered.
"This approach rewards facilities that consistently dispense prescribed medicines while ensuring payments reflect the actual level of service provided," the notice says.
SHA has directed all contracted primary healthcare facilities to provide and accurately record the complete package of care, including prescribed medicines, to ensure beneficiaries receive the services covered under the PHC benefit package.
The authority advised facilities seeking further clarification to contact SHA through its toll-free number 147 or via its official email address.
