The Social Health Authority (SHA) in Kenya has introduced new requirements for health facilities to sign contracts, ensuring that facilities are licensed to provide the services they offer. This move aims to strengthen regulatory compliance, improve the quality of care, and enhance patient safety. The new guidelines will determine which services hospitals can offer under the 2026-2029 health insurance contracts.
According to the new arrangement, a facility cannot use its SHA contract to offer or claim payment for a service unless it holds the relevant license. For instance, laboratory services must be licensed by the Kenya Medical Laboratory Technicians and Technologists Board (KMLTTB), pharmacy services by the Pharmacy and Poisons Board (PPB), and imaging services by the Kenya Nuclear Regulatory Authority (KENRA).
The Health Cabinet Secretary, Aden Duale, and the Health Committee of the Council of Governors (CoG) agreed to these requirements. They emphasized that facilities will only be contracted for services for which they are duly licensed. The National and County Governments have reaffirmed their commitment to ensuring that eligible public health facilities complete the contracting process on time.
Level Four and Level Five facilities have been given three months to meet the compulsory laboratory licensing requirements. This move is part of the implementation of the 2026-2029 contracting cycle. The current facility contracts have been extended to October 14, 2026, and will not be extended further.
The SHA will establish a digital platform called HAKIKA to manage the contracting of healthcare providers. The platform will help eligible facilities complete the contracting process. The SHA aims to contract clinics in every county by October 14.
Facilities that have met all other contracting requirements will have 30 days to submit any outstanding documentation from relevant authorities, such as the National Social Security Fund (NSSF) and the National Environment Management Authority (NEMA). The stakeholders have also agreed on a 90-day timeline for the payment of clean claims.
The SHA is required to pay clean claims within 90 days of receipt, in the order in which they were received. If available funds are insufficient to settle a clean claim within the 90 days, the unpaid amount will be recognized as a certified liability and carried forward for settlement within the same financial year.
Key points
- Health facilities in Kenya must be licensed to provide services they offer under SHA contracts.
- The SHA has established a digital platform, HAKIKA, to manage healthcare provider contracting.
- Facilities have 30 days to submit outstanding documentation and a 90-day timeline for clean claims payment.
