Faith Masita
The Ministry of Health has issued a policy directive to the Social Health Authority (SHA) mandating that qualifying Level 2 and Level 3 healthcare facilities be enabled to receive maternity service reimbursements under the national health insurance framework. This move is part of broader efforts to expand access to maternal healthcare and strengthen Kenya’s Universal Health Coverage (UHC) agenda.
Health Cabinet Secretary Hon. Aden Duale emphasized that the directive is aimed at ensuring that more pregnant women across the country can access quality maternity care without prohibitive out-of-pocket costs. He said the ministry has taken steps to align SHA operations with the primary healthcare policy, enabling reimbursement for deliveries and related maternal services at lower-level facilities that are certified and meet regulatory standards.
Under the Social Health Insurance Act, maternity services delivered at Level 2 and Level 3 facilities, when empanelled and contracted by SHA, are eligible for funding from the Primary Healthcare Fund (PHF), including normal deliveries and caesarean sections as outlined in the scheme’s benefit package.
According to data shared by the ministry, more than 900,000 beneficiaries have so far accessed maternity and other primary health services supported by SHA, signalling early uptake of the expanded coverage.
The policy adjustment responds to concerns raised by healthcare providers and county officials about gaps in funding at the primary care level, where many expectant mothers traditionally seek delivery services. Previously, some facilities had faced challenges in getting reimbursed for maternity care due to administrative and contractual hurdles. The directive aims to remove such barriers and ensure timely settlement of legitimate claims, improving cash flows for frontline facilities.
However, the implementation of SHA has not been without controversy. Healthcare stakeholders have criticised delays in payment of claims and disputes over reimbursement rates, with some private and faith-based hospitals threatening service disruptions over outstanding reimbursements.
Despite these challenges, CS Duale has repeatedly defended the reforms, stressing the importance of strengthening accountability, tackling fraudulent claims and streamlining systems to protect both patients and providers as part of Kenya’s transition to a more comprehensive health insurance model.
Health Cabinet Secretary Hon. Aden Duale emphasized that the directive is aimed at ensuring that more pregnant women across the country can access quality maternity care without prohibitive out-of-pocket costs. He said the ministry has taken steps to align SHA operations with the primary healthcare policy, enabling reimbursement for deliveries and related maternal services at lower-level facilities that are certified and meet regulatory standards.
Under the Social Health Insurance Act, maternity services delivered at Level 2 and Level 3 facilities, when empanelled and contracted by SHA, are eligible for funding from the Primary Healthcare Fund (PHF), including normal deliveries and caesarean sections as outlined in the scheme’s benefit package.
According to data shared by the ministry, more than 900,000 beneficiaries have so far accessed maternity and other primary health services supported by SHA, signalling early uptake of the expanded coverage.
The policy adjustment responds to concerns raised by healthcare providers and county officials about gaps in funding at the primary care level, where many expectant mothers traditionally seek delivery services. Previously, some facilities had faced challenges in getting reimbursed for maternity care due to administrative and contractual hurdles. The directive aims to remove such barriers and ensure timely settlement of legitimate claims, improving cash flows for frontline facilities.
However, the implementation of SHA has not been without controversy. Healthcare stakeholders have criticised delays in payment of claims and disputes over reimbursement rates, with some private and faith-based hospitals threatening service disruptions over outstanding reimbursements.
Despite these challenges, CS Duale has repeatedly defended the reforms, stressing the importance of strengthening accountability, tackling fraudulent claims and streamlining systems to protect both patients and providers as part of Kenya’s transition to a more comprehensive health insurance model.
