Nyikal: Health committee probes SHA payment flaws, system failures
By Aloys Michael, September 3, 2025The Chairperson of the National Assembly Health Committee, James Nyikal, has raised serious concerns over systemic failures and financial irregularities in the Social Health Authority (SHA) programme, following site visits to public and private healthcare facilities.
Speaking during an interview on a local TV station on Wednesday, September 3, 2025, Nyikal disclosed that the committee had uncovered a confusing and inefficient payment structure under SHA, as well as troubling disparities in how the system operates in public versus private hospitals.
“We visited two facilities with the same name but under different management. One is in Nairobi, and the other is outside. They are not connected, but because of the name, it creates confusion. We need to visit both to fully understand what is going on, especially because the Nairobi one is directly affected by this issue,” he said.
The committee is investigating claims that SHA has not only failed to pay hospitals on time but also lacks proper tracking of what has been paid versus what is still owed.
“We are not just looking at the money that has been properly paid but also at the debts owed to these facilities. In some cases, the debts owed are far greater than the payments received,” Nyikali explained.
One of the key problems, he noted, lies in the lack of transparency in the reimbursement process.
“Payments go directly to banks, but when you ask a facility what they have been paid for and what is still pending, they cannot give a clear answer. That information seems to only exist within SHA itself,” he said.
SHA saga
The Seme MP also expressed concern about communication breakdowns between healthcare facilities and the SHA system.
“There is no proper channel for hospitals to raise concerns or get help. The NHIF offices that used to support these services are no longer functional, and the digital system that was meant to replace them is not working,” the legislator stated.
The committee found that private facilities seem to understand the SHA process better than public ones, suggesting a lack of training or rollout clarity in the public sector.
Nyikal highlighted another critical gap in outpatient care. Under the current system, outpatient services are not adequately covered by the Boresha Jamii (BUSA) plan, the affordable premium option.
“Outpatient care should be covered under primary healthcare, but that system is not in place. So patients are either being turned away or forced to pay out of pocket,” he said.
While some public hospitals claim they are waiving fees for such patients, Nyikal voiced scepticism.
“I suspect that many are being sent away without treatment or are forced to pay.”
He said the committee’s investigation will continue, with planned visits to both government and private hospitals to further assess the extent of the issues.
“We are now looking at a broader issue. There is the fraud, the debt, and most importantly, the failure of systems that is creating real problems for facilities and patients alike,” he asserted.