Kenyan hospitals will no longer be paid by the Social Health Authority (SHA) simply for being on its list of contracted facilities. Under new rules, a hospital can only claim reimbursement for services it is specifically licensed to provide.
The change comes with SHA’s 2026-2029 contracting cycle, rolled out under the HAKIKA framework. Current facility contracts were extended to October 14, 2026, and the government insists that date will not move again.
Hospitals Must Have Specific License
Until now, being a licensed, contracted hospital was largely the key to the whole door. That is changing. Each service a facility offers has to be cleared by the regulator responsible for it
For example, laboratory services must be licensed by the Kenya Medical Laboratory Technicians and Technologists Board (KMLTTB), while pharmacy services require approval from the Pharmacy and Poisons Board (PPB). Imaging services are subject to licensing by the Kenya Nuclear Regulatory Authority (KENRA)
In practice, a hospital can stay open and keep treating patients while being barred from billing SHA for a department that lacks the right approval. The Ministry of Health says the goal is to tighten compliance, raise the quality of care, and keep patients safe.
Hospitals Could Lose Reimbursement for Unlicensed Services
A missing license does not automatically cost a hospital its entire SHA contract. The facility stays contracted for the services where it meets the requirements, and only the unlicensed ones are cut off from reimbursement.
For patients, this means a hospital’s lab or imaging unit may not be covered even if the rest of the facility is. Those patients could be sent elsewhere for the service.
Level 4 and Level 5 Hospitals Given Three Months
Level 4 and Level 5 facilities have been given three months to get their laboratory licenses in order, which is now compulsory.
The Ministry of Health and the Council of Governors have also told eligible public facilities to finish contracting within the set timelines so SHA beneficiaries do not face disruption.
New Digital Contracting System
The whole process now runs through SHA’s E-Contracting Platform. Providers can apply, upload documents, have their licences verified, sign contracts electronically and follow the progress of their applications. To help facilities beat the October 14 deadline, SHA has set up contracting clinics in counties.
Facilities that have met every other requirement but are still waiting on certain statutory documents get a 30-day conditional compliance window. The documents in question come from bodies such as the National Social Security Fund (NSSF), the National Environment Management Authority (NEMA), Fire safety authorities, the National Council for Persons with Disabilities (NCPWD), and the Office of the Data Protection Commissioner (ODPC)
However, the conditional compliance period does not remove the facilities’ obligation to obtain the required statutory documents.
SHA Sets 90-Day Payment Timeline for Clean Claims
The new framework also sets a 90-day payment window for clean claims, which SHA says it will process in the order they arrive. A clean claim is one that meets all conditions and needs no clarification or correction.
If funds run short, the unpaid amount will be recorded as a certified liability and carried forward for payment within the same financial year, depending on fund availability.
Knowing that a hospital is “on SHA” may no longer be enough. Patients may need to confirm that the facility is contracted for the particular service they need, whether that is a lab test, a scan, or a prescription, before they go.
With current contracts expiring on October 14, hospitals are racing to complete the process as the country enters the 2026-2029 financing cycle.
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