SHA CEO Mercy Mwangangi
The Social Health Authority (SHA) has directed all healthcare providers contracted under its scheme not to deny, delay, or withhold emergency medical treatment from patients because of their inability to pay.
In a notice on August 1, SHA reminded healthcare providers that the right to emergency medical treatment is guaranteed under Article 43(2) of the Constitution of Kenya.
The authority emphasized that all SHA-contracted facilities are contractually obligated to provide mandatory emergency services, regardless of a patient’s financial status.
“Every SHA-contracted provider is contractually obligated to provide mandatory emergency services and shall not refuse, delay or withhold emergency treatment on account of a patient’s inability to pay or for any other financial reason,” the notice stated.
The authority clarified that no patient requiring emergency medical treatment should be denied care, delayed, referred or transferred solely because they are unable to pay, lack benefit confirmation, or have not provided a deposit, advance payment or financial guarantee.
SHA also explained that the Emergency, Critical and Chronic Illness Fund (ECCIF) will finance eligible emergency treatment for the first 24 hours.
After that period, eligible services will be covered under the Social Health Insurance Fund (SHIF) or through other applicable payment arrangements.
For facilities that lack the capacity to continue managing a patient, SHA directed that the patient be stabilized before being referred to an appropriate contracted health facility, in accordance with the Ministry of Health Referral Guidelines and the SHA contract.
“Where a provider lacks the capacity to continue managing a patient, the patient shall first be stabilised and then referred to an appropriate contracted facility in accordance with the Ministry of Health Referral Guidelines and the SHA Contract,” SHA stated.
The authority warned that healthcare providers found violating the directive risk de-empanelment and other contractual enforcement measures, including termination of their SHA contracts.
SHA instructed chief executive officers, medical superintendents, facility administrators, and emergency department staff to ensure that the notice is brought to the attention of all clinical, admissions, and finance personnel and that the directive is implemented immediately.
“Any provider found to have engaged in such conduct shall be liable to de-empanelment and other contract enforcement measures, including termination of the SHA Contract, without prejudice to any action that may be taken by the relevant regulatory or enforcement authorities,” the notice added.
