SHA promised quality medical care, but it bleeds taxpayers' funds

While majority of Kenyans struggle to access quality health care, billions of taxpayers’ money is being lost under the new health scheme that was meant to improve access to medical care by disadvantaged Kenyans and curb fraud.

A number of hospitals have been flagged for working closely with Social Health Authority (SHA) leadership to mint millions of shillings while they give little in the quest to improve the country’s health services.

Claims payments have continued to spark public outrage as questions now emerge on expenditure of taxpayers’ funds at the Authority which had promised to weed out graft as witnessed under the defunct National Health Insurance Fund (NHIF).

Ladnan Hospital is among facilities of interest linked to a senior official in the ministry.

The hospital operates under three names within SHA;  Ladnan Hospital, Ladnan Medical Clinic and Ladnan Hospital Elwak.

The Nairobi based (Ladnan Hospital) facility in Pangani, Nairobi has received a minimum of Sh195 million, since SHA became operational in October last year, while Ladnan Medical Clinic in Elwak, Mandera County has received a minimum of Sh27 million, with some payments not made public.

In December alone last year, Nairobi-based Ladnan received Sh55,594,460, whereas Ladnan Medical Clinic received Sh6,835,570.

The facility in Elwak received a claim of Sh2,442,420, for the month of March, May and June. Payments for the months of January, February, April, June and August were not made public.

“Payment of Sh27 million, for Ladnan Medical Clinic in Wajir is abnormal for a medical clinic. The payment is too high,” said a healthcare IT expert based in Nairobi who was reluctant to be named.

“The hospital which is a Level 3 clinic should be fetching about Sh8 to Sh10 million, because of the services it offers”.

The IT expert is a digital fraud detector specialising in health technology.

A Level 3 facility, according to the expert, is an outpatient one treating routine illnesses like flu, cough, malaria and diarrhoea.

The doctor compared Ladnan Hospital to some private facility, both in Nairobi registered as Level 4, that have a huge disparity in terms of payments.

For example, in January this year, Ladnan Hospital received a total of Sh8.34 million as compared to similar Level Four Hospital in Nairobi that got a total of Sh1.895 million.

Accumulatively, by May this year, Ladnan Hospital received Sh118.644 million, whereas a private facility of the same cluster received Sh26.33 million.

Ladnan, according to Rural and Urban Private Hospitals Association of Kenya (RUPHA), is an entity of interest because of the relationship it has with the SHA chairperson, Abdi Mohammed, who is said to be a co-founder long before his appointment.

Dr Abdi has, however, been quoted to have said he sold the entity to new owners and no longer holds interest in it.

“Even if the relationship is of him being the founder, indeed he is the founder,” said RUPHA chairperson, Brian Lishenga.

“This is a hospital of interest. He has to come out. The burden of proof is in his docket. He has to come out to prove that the hospital is not benefiting unfairly by virtue of his association with it, even if it is historical,”  said Dr Lishenga.

Some hospitals flagged in the SHA scheme were found to be in deplorable condition. For instance, some facilities classified as Level 4 lack a single inpatient bed, while others operate from a single room resembling a kiosk.

Kenya Medical Practitioners and Dentists Council (KMPDC) Chief Executive Officer David Kariuki yesterday said ownership details on the number of registered hospitals are in custody of SHA.

“SHA has details of how many hospitals they have contracted, and deal with,” said Dr Kariuki.

“We (KMPDC) do licensing of hospitals, but then SHA decides which to accredit.”

At the same time, Health Cabinet Secretary Aden Duale yesterday dismissed questions around the Ladnan issue but admitted that SHA chairperson was once a proprietor of the entity.

“Social Health Authority Chairman Abdi Mohamed used to own Ladnan Hospital, but he left it and there is no conflict of interest in that” Dualle said

Lishenga questioned the hospital’s December payment which he said is well beyond amounts payable to a hospital of such lowly standing.

“One of the biggest payments was made in December last year. The biggest red-flag is the payment the hospital got in December last year. Sh55 million in December last year is too high. My interest is on payments made in December. At that time, SHA had been in operation for only five weeks,”  said Lishenga.

Transition of claims with the new health scheme made in October was manual, save for mid-November and December. “The payment is a red-flag. Remember, we had only had SHA for three months, in October, we transitioned, and half of October we did manual claims that were not paid, and in November, we did claims, and by the time they paid in December. Where had the hospital gotten claims worth Sh52 million?’’ posed Lishenga.

Last week, SHA published a list of hospitals that the public including other hospitals have continued to poke holes in, demanding transparency and accountability from SHA leadership and the Ministry of Health.

According to the list made public on the SHA portal, Sh3.1 billion was paid to 1,429 hospitals across the country in August, including private, public and faith based hospitals.

However, amid increased scrutiny from Kenyans and experts, the Authority last evening pulled down its portal locking away payment list and later disabled the Kenya Master Health Facility Registry (KMHFR).

With the site disabled, it has become difficult for the public to verify hospital details and track payments.

Publishing the payment list is crucial in promoting accountability and transparency.

The KMHFR contains critical data on all health facilities, including their geographical location, bed capacities, and regulatory bodies.

“It is a public site, and by pulling it down, the ministry is going against the right to access information. It also shows a ministry that has no control over its own data,” said Lishenga

RUPHA has threatened to protest the move and take legal action, accusing the ministry of attempting to cover up corruption and exposing its inefficiencies.

‘‘Pulling the site down means the ministry has lost confidence in its own regulatory bodies,”Lishenga added.

According to the list accessed earlier by The Standard, Rift Valley Provincial General Hospital in Nakuru received the biggest share of the payout, totalling Sh96,553, 620.

Jumia Hospital Huruma received the second-highest share of Sh87, 062, 778, whereas Kenyatta National Hospital, that provides specialised services, received Sh70,182.629.

KHN’s received an addition of Sh30,377,690 for its amenity wing (private wing). 

Moi Teaching and Referral Hospital (MTRH) in Eldoret received Sh67, 160, 353, with AIC Kijabe receiving Sh59,579, 424.

Other hospitals that received high amounts from the social health scheme included Jaramogi Oginga Odinga Teaching and Referral Hospital (Sh63,515, 375).

The list of claims according to RUPHA is mixed up, with no clarity, which might be an avenue for corrupt deals.

“Payments according to SHA were made in August, but we do not know which period the payment is for,” said Lishenga.

Under the defunct NHIF, payment for claims would indicate the period of pay, and services offered for instance medical services, bed, and the months being paid for.

“SHA produced a list of payment, which we do not know much about,” said Lishenga.

He added, “Nobody knows, it tells when payment was made. For what procedure and when. ”

Shockingly, payments were made to some ghost facilities, with some that are in a deplorable State.

Divine Sparkle Medical Centre in Rangwe is said to have received Sh2.8 million in June, despite having received Sh7,000 in April.

The facility is allegedly owned by Labwe Farmers Sacco, with its back section being a residential block.

The facility is located in a remote town, with low traffic of people, with the public questioning its financial capabilities, of residents being below average.

Qarsadamu Medical Centre, is documented to have received Sh2.8 million in June. Surprisingly, the hospital does not exist.