Government Bans Illegal Hospital Charges for Civil Servants Under New SHA Tariffs

Kenya's government has introduced a new tariff framework under the Public Officers Medical Scheme Fund (POMSF), standardising charges across contracted hospitals and prohibiting unauthorised fees for civil servants.

Health Cabinet Secretary Aden Duale said the Social Health Authority (SHA) has integrated the agreed tariffs into its system, preventing healthcare facilities from charging illegal co-payments to public officers. Hospitals that fail to comply will face sanctions, including suspension from the scheme and requirements to refund affected patients.

The measures follow months of complaints from civil servants who reported being detained in hospitals, experiencing delays in treatment approvals, or being asked to pay additional fees during the transition to the new health financing system. Duale said the reforms are intended to rebuild confidence in the scheme and protect public officers from unfair charges, stating: "Walk in. Receive care. Walk out."

Negotiations with private and faith-based healthcare providers have resulted in contracts that establish reimbursement rates and clinical guidelines. The scheme, created under Legal Notice No. 195 of 2024, significantly expands healthcare benefits for public officers.

Coverage includes outpatient and inpatient treatment, specialised surgical procedures, cancer care, renal dialysis, dental and optical services, reproductive healthcare including in vitro fertilisation (IVF), and selected treatment abroad.

By embedding the tariffs within the SHA system, the government aims to eliminate informal billing practices that have affected healthcare access.

Hospitals are required to follow approved rates and pre-authorisation procedures, while SHA has been given the authority to enforce compliance. Duale warned that any facility found violating the agreed terms would face immediate disciplinary action, reflecting the government's strict approach to enforcement.

The reforms are also intended to strengthen Kenya's wider health financing system by promoting affordability, sustainability and consistent access to healthcare services for public officers. Healthcare providers involved in the negotiations have committed to supporting the new framework. 

Duale said their cooperation would be essential in ensuring uninterrupted healthcare services. The government has pledged to closely monitor implementation to prevent the return of unauthorised billing practices.