By Mandere Onyinkwa
The Council of Governors has asked the Social Health Authority (SHA) to defer the new contracting framework for county public health facilities.
The county chiefs argue that several requirements by the Authority are incompatible with the legal and administrative structure of devolved healthcare.
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In a letter to SHA chief executive officer Dr Mercy Mwangangi, the Council said public health facilities from Level 2 to Level 5 are owned, managed and operated by county governments and should not be treated in the same way as private healthcare providers.
“Public health facilities are service points of the county government, NOT separate legal entities or private businesses,” said the Council, which is chaired on health matters by Mombasa Governor Abdulswamad Shariff Nassir.
The governors said the contracting requirements had been designed as though county facilities were independent providers, leaving them unable to meet some of the conditions imposed by SHA.
They also challenged the authority of facility managers to enter into contracts with SHA, arguing that such agreements must follow county government legal and administrative procedures.
The Council cited the Facilities Improvement Financing Act, 2023, saying the county chief officer responsible for health is the accounting officer, while medical superintendents and facility in-charges only have authority to incur expenditure as delegated by the chief officer.
“Facility-level officers therefore have no mandate to bind the county to contractual obligations,” the letter said.
The Council further raised concern that SHA’s contracts could extend the authority’s role into verification and enforcement functions assigned by law to bodies including the Kenya Medical Practitioners and Dentists Council, the National Environment Management Authority, the Office of the Data Protection Commissioner and county governments.
It said county leadership had also not been adequately involved in consultations over the proposed contracts.
The Council wants SHA to extend existing contracts and defer implementation of the new framework for public facilities to prevent disruption of services and payments.
It has asked SHA to provide written responses to the concerns raised by October 12 and convene a meeting involving the authority, the Council and county health departments to agree on requirements applicable to public facilities.
The intervention, however, does not automatically resolve the challenges facing private and faith-based facilities seeking SHA contracts.
A separate advisory circulating among healthcare providers has urged private and faith-based facilities to continue complying with the contracting requirements while challenging provisions they consider unlawful, duplicative or unreasonable through appropriate channels.
The advisory warned that failure to secure an SHA contract could have serious financial consequences for private providers, particularly as many households struggle to meet healthcare costs from their own pockets.
It urged facilities to ensure statutory remittances, financial statements, licences and other compliance documents are in order before submitting their applications.
Of particular importance, providers were advised to ensure that the legal name appearing on their Kenya Medical Practitioners and Dentists Council licence matches exactly the name on their bank account and information submitted to SHA.
“Submit within the stipulated timelines and preserve copies and evidence of every submission,” the advisory said.
It also questioned requirements relating to single or unified business permits, arguing that administrative changes should not be used to settle unresolved legal questions over fees imposed on healthcare facilities.
The advisory further called for greater clarity on SHA’s obligations to healthcare providers, particularly payment for services already delivered and verified.
“A contracting relationship cannot sustainably operate as a one-way compliance exercise,” it said, noting concerns over outstanding legacy NHIF claims and delayed SHA payments.
The Council of Governors similarly argued that verified claims for services already rendered should be treated as debts with defined payment timelines rather than being left indefinitely dependent on future appropriations.
With the contracting process ongoing, healthcare providers face the immediate task of meeting the requirements while broader legal and policy questions are considered by the authorities and stakeholders.
