The Social Health Authority (SHA) is on the spot over delays in remitting billions of shillings owed to county health facilities, a crisis that now threatens healthcare delivery across the country.

The Senate Public Investments and Special Funds Committee has decided to summon SHA CEO Dr Mercy Mwangangi to appear before it and provide a detailed status report, payment schedule, and outstanding balances owed to the 47 counties.

The Senate Committee Vice Chairperson Eddy Oketch said they will invite the SHA CEO to provide a status report after Governors raised concerns over the outstanding remittances from the defunct National Hospital Insurance Fund (NHIF).

“We have asked the SHA CEO to come before us and explain why SHA has not cleared the debt owed to counties some of which were inherited from the defunct National Hospital Insurance Fund which has affected the delivery of health services,” said Oketch.

Makueni Governor Mutula Kilonzo who chairs the Council of Governors’ Legal Affairs Committee, revealed that SHA owes counties over Sh9 billion, a debt inherited from NHIF while they equally owe Kenya Medical Supplies Authority (KEMSA) nearly Sh4 billion.

Mutula said that Governors are proposing a debt swap so that the money that NHIF or SHA owe the facilities be given to KEMSA so that services are not interrupted stating that most counties are being denied medical supplies by KEMSA, crippling healthcare services, while SHA is holding billions owed to facilities. 

Governor Mutula painted a grim picture of the state of county health facilities, warning that shortages in drugs, staff and equipment are undermining efforts to roll out Universal Health Coverage (UHC) stating that only Mombasa and Makueni do not have pending bills with KEMSA.

“Counties are facing challenges because of the budget, the health function has not been properly costed that is why we have budgetary challenges to fully perform this function, in Makueni, 38 per cent of the county’s total budget is allocated to health out 3,900 workers, 2,200 serve in the health department,” said Mutula.

He said that in Makueni they have 242 health facilities, out of which about 150 have only one nurse attending to over 2,000 patients every month, stating that this is the situation in other counties which are suffering from acute shortages of nurses, medical officers, and specialists such as neurosurgeons.

Mutula said frequent stockouts, pilferage and inefficiencies at KEMSA are major bottlenecks to service delivery and that the state agency being unable to consistently supply essential medical commodities, counties have turned to private suppliers to keep hospitals running.

The Governor told the Senate Committee that in order to prevent theft and mismanagement his administration is digitizing hospital inventory systems, aiming to enhance accountability and prevent recurring shortages to ensure efficient health services delivery.

Senators at the meeting decried the situation, promising to push for more resources to be devolved from the Ministry of Health, which still retains over Sh100 billion despite having limited operational functions wondering why all this money is left at the headquarters.

“It does not make sense for the Ministry of Health to continue holding a budget of over Sh100 billion for only formulating policies while the function is devolved with counties facing various challenges in running the crucial sector,” said Mutula.

Machakos Senator Agnes Kavindu highlighted the mental and physical strain on overworked health workers, noting that many are enduring long hours with no leave, leading to burnout, depression, and even suicide.