Private hospitals threaten legal action over 'unfair' facility downgrades
The Rural Private Hospitals Association of Kenya chairman Brian Lishenga.
Private hospitals across the country are demanding the immediate reinstatement of facilities that were closed or downgraded by medical authorities, threatening court action over what they describe as a flawed process that lacked transparency and due process.
The Rural and Urban Private Hospitals Association of Kenya (Rupha) has written a letter to the Kenya Medical Practitioners and Dentists Council (KMPDC), dated June 30, demanding explanations for the recent downgrading of several member facilities from Kenya Essential Package for Health (KEPH) Level 3 to Level 2 status.
"Who wakes up and decides to close or downgrade facilities without a warning, without explanation, and without a chance to fix whatever problems allegedly prompted the action?" questioned Rupha Chief Executive Officer Cynthia Mukami Munene. "What procedures were followed? No assessment was done in the said hospitals."
Last month, over 1,029 health facilities across Nyamira, Kisii, Mandera, Wajir, and Nairobi counties were either shut out of the Social Health Authority (SHA) system or downgraded, significantly altering their service delivery capacity. The scale of the action was extensive, with Nairobi recording 1,017 facilities inspected, 394 closed and 23 downgraded.
In Kisii, 291 facilities were inspected with 120 closed and 63 downgraded, while in Mandera, 269 facilities were inspected with 58 closed and 60 downgraded. Wajir saw 239 facilities inspected with 77 closed and 114 downgraded, and in Nyamira, 167 facilities were inspected with 79 closed and 41 downgraded.
The most affected facilities were Level 3 hospitals that previously offered inpatient services, specialised clinics, including dental and X-ray facilities, and comprehensive maternity care with antenatal and postnatal services. These crucial services are now unavailable through the SHA system.
Health Cabinet Secretary Aden Duale defended the mass action, saying that, "the goal is clear: to eliminate fake, unlicensed facilities operating across the country so as to guarantee quality of care for all Kenyans." Duale maintained that the affected facilities were non-compliant, adding that, "through digitalisation, the Medical Council, working closely with the Digital Health Agency (DHA) and SHA, has identified and closed 728 non-compliant facilities and downgraded 301 facilities."
However, Rupha argues that KMPDC failed to follow its own established guidelines for facility categorisation. The association references the "Joint Health Inspection Checklist" and "Risk Rating Table to Guide Decisions on Risk Categorisation of Facilities and Accompanying Recommended Actions," which outline specific procedures for downgrading actions. "
According to the Joint Health Inspection Checklist, it is clear that specific steps, including written notice, timelines for correction, and the right to request re-inspection for re-categorisation, should guide any downgrading action," the letter states.
Rupha claims these procedures were ignored, "leading to confusion among facilities and potential disruption of service delivery planning." The association noted with concern that downgrades were implemented "without prior communication to the affected facilities outlining the reasons for this change."
To date, facilities have not received official communication or an opportunity to understand the basis for the decisions.
In their letter to the medical council, Rupha has made three specific demands: a detailed explanation of the specific reasons for downgrading each affected facility; clarity on the procedures followed in arriving at the downgrading decisions; and guidance on the remediation steps that facilities should take to address the identified issues, as well as the process for re-inspection and re-categorisation.
The downgrades will significantly impact the facilities' ability to provide certain levels of care and could potentially affect their eligibility for insurance reimbursements, including those from the Social Health Authority.
"The situation is acute for specialised services that were previously available at the said facilities but are now not accessible to Kenyans following downgrades," Rupha noted.
Rupha chairperson, Dr Brian Lishenga, said the association's intends to pursue legal action. "We will take KMPDC to court. We are building the case."
The dispute comes as an additional 31 hospitals have been closed for alleged billing fraud under the new SHA system, while many other facilities have been delisted or downgraded for various compliance issues. The healthcare sector upheaval threatens to disrupt service delivery across the country, particularly affecting specialised medical services that many Kenyans depend on for critical care.
