The Social Health Authority (SHA) has directed all contracted healthcare providers to comply with their legal and contractual obligation to offer emergency medical treatment without discrimination, warning that facilities that fail to do so risk being de-empanelled.
In a notice issued by SHA Chief Executive Officer Dr Mercy Mwangangi, the authority reminded healthcare providers that the right to emergency medical treatment is guaranteed under Article 43(2) of the Constitution of Kenya and must be upheld regardless of a patient's financial status.
Mwangangi said all SHA-contracted healthcare providers are required to provide mandatory emergency services and must not refuse, delay or withhold treatment because a patient is unable to pay, lacks benefit confirmation or has failed to provide a deposit, advance payment or financial guarantee.
“No patient requiring emergency medical treatment should be denied care, referred or transferred solely on financial grounds,” Mwangangi said.
The notice further states that the Emergency, Critical and Chronic Illness Fund (ECCIF) will finance eligible emergency treatment for the first 24 hours. Thereafter, eligible services will be covered through the Social Health Insurance Fund (SHIF) or other applicable payment arrangements.
Where a healthcare facility lacks the capacity to continue managing a patient, SHA directed that the patient must first be stabilised before being referred to an appropriate contracted facility in line with the Ministry of Health Referral Guidelines and the SHA contract.
The authority warned that providers found to have violated the directive would face contract enforcement measures, including de-empanelment and possible termination of their SHA contracts, in addition to any action that may be taken by relevant regulatory or enforcement agencies.
SHA also instructed chief executive officers, medical superintendents, facility administrators and emergency department staff to immediately circulate the notice to all clinical, admissions and finance personnel and ensure full compliance.
There have been growing concerns over reports that some healthcare facilities have delayed or denied emergency treatment to patients while awaiting confirmation of SHA benefits or demanding upfront payments.
In several cases, patients and their families have alleged that hospitals required deposits or proof of coverage before initiating emergency care, raising concerns about compliance with constitutional and legal obligations.
The issue has sparked public debate over the implementation of Kenya's new social health insurance system, with healthcare providers citing delays in reimbursement, verification challenges and financial constraints as factors affecting service delivery.
Under Article 43(2) of the Constitution, every person has the right to emergency medical treatment.
SHA has reiterated that all contracted providers are legally and contractually required to stabilise and treat emergency patients regardless of their ability to pay or the status of their insurance verification.
