Healthcare Standoff Turns Deadly

NAIVASHA, KENYA – A deepening crisis in Kenya's healthcare sector has reached a devastating new stage, with the Council of Governors (CoG) directly linking the deaths of at least 934 newborns in hospitals this year to critical funding failures by the new Social Health Authority (SHA). In a statement issued Wednesday, November 19, 2025, following a tense meeting in Naivasha, county leaders threatened a complete withdrawal from the SHA, a move that could collapse the country's nascent universal healthcare framework.

The dispute centres on an alleged decision by the SHA to halt reimbursements for maternity services at Level 2 (dispensaries) and Level 3 health facilities, which form the backbone of primary healthcare for millions of Kenyans, particularly in rural and remote areas. Governors argue this policy has triggered a sharp decline in women giving birth in health facilities, directly contributing to preventable deaths.

“We are going to pull out of SHA if it continues with this behaviour of not reimbursing claims for level-two and even level-three hospitals,” declared Mandera Governor Mohamed Adan Khalif on Wednesday. “A dispensary in Mandera, at the border with Ethiopia, is like the Aga Khan and Nairobi Hospital of Mandera. Denying deliveries at dispensaries and health centres is retrogressive.”

A System in Financial Distress

The governors' ultimatum exposes the severe operational and financial turmoil that has plagued the transition from the long-standing National Health Insurance Fund (NHIF) to the SHA. Launched as a cornerstone of the government's Universal Health Coverage (UHC) agenda, the SHA's rollout has been marred by systemic glitches, reimbursement delays, and widespread confusion among both patients and healthcare providers.

County governments and private hospitals report being crippled by billions of shillings in unpaid claims, jeopardizing their ability to procure essential medicines and pay staff. Nyeri Governor Mutahi Kahiga recently stated that SHA owes his county Sh230 million, in addition to Sh289 million in legacy debt from the NHIF, forcing hospitals to postpone critical procurements. The situation is equally dire in the private sector, where the Rural and Urban Private Hospitals Association (RUPHA) estimates that over Sh80 billion is owed by the government, pushing many facilities to the brink of collapse.

“SHA should urgently start funding level-two facilities,” said Tharaka Nithi Governor Muthomi Njuki, the newly elected CoG Vice-Chairman, on Wednesday. He argued that since pregnancy is not a condition that can be faked, the outcome—a mother and a baby—is visible proof of service rendered and should be compensated without delay.

The Human Cost of Policy Deadlock

While the national government and counties clash over finances and regulations, the human cost is mounting. The reported 934 newborn deaths since January represent a significant setback for Kenya, a nation that struggles with a neonatal mortality rate of 21 deaths per 1,000 live births, far from the Sustainable Development Goal target of 12 per 1,000 by 2030. Annually, Kenya loses an estimated 33,600 newborns and 5,680 mothers from largely preventable causes.

The Ministry of Health has countered the governors' claims, stating that there is no official directive to cease funding for deliveries in any facility. However, it maintains that for Level 2 facilities to be reimbursed for inpatient services like childbirth, they must upgrade their infrastructure and obtain the necessary licenses from the Kenya Medical Practitioners and Dentists Council (KMPDC). This regulatory stance, governors argue, ignores the reality on the ground where local dispensaries are often the only accessible option for expectant mothers.

The timing of this public fallout is particularly poignant, coming just as the CoG launched a new inter-county digital platform—the Maternal and Perinatal Death Surveillance and Response (MPDSR) initiative—designed to track and reduce maternal and newborn deaths in real-time. The very system created to save lives is now threatened by the funding paralysis that is allegedly causing them.

As the standoff continues, the core promise of the Social Health Authority—to provide equitable and accessible healthcare for all Kenyans—is facing its most severe test. The resolution of this dispute will not only determine the future of devolution in the health sector but will also have life-or-death consequences for mothers and babies across the nation.