NAIROBI, Kenya, Jul 22 – The Social Health Authority (SHA) has announced a new reimbursement model that will reduce payments to contracted primary healthcare facilities that fail to dispense prescribed medicines, in a move aimed at ensuring patients receive the full range of services covered under the Primary Healthcare (PHC) Fund.
In a public notice issued on Wednesday, SHA said it had identified gaps in medicine dispensing at some facilities, leaving beneficiaries with only part of the care guaranteed under the PHC benefit package despite providers receiving funding for comprehensive treatment.
The Authority said the PHC package covers the entire episode of care as prescribed under Ministry of Health treatment guidelines, including consultations, diagnosis, laboratory investigations, treatment and prescribed medicines.
“To strengthen accountability, SHA will monitor each facility’s medicine-dispensing rate through the Digital Health Agency platform and reimburse for the service given,” SHA Chief Executive Officer Dr. Mercy Mwangangi said.
Under the new payment framework, SHA will first determine each facility’s monthly reimbursement using the existing weighted global budget capitation model.
A fixed portion of the reimbursement will be allocated to medicines, while the remaining amount will cater for consultations, staff costs, diagnostics, consumables, overheads and other service delivery expenses.
Facilities will then be assessed based on their medicine dispensing rate—the percentage of prescribed medicines that are actually issued to patients and captured in the approved digital system.
A facility that dispenses 100 percent of prescribed medicines will receive the full pharmacy payment. However, a facility that dispenses only 80 percent of prescribed medicines will receive 80 percent of the pharmacy allocation, with the remaining 20 percent deducted.
The non-pharmacy component of the reimbursement will remain unaffected.
SHA said the new approach is intended to reward facilities that consistently provide complete care while ensuring public funds reflect services actually delivered.
The Authority has directed all contracted primary healthcare providers to ensure they dispense prescribed medicines and accurately record all services through the approved digital platform to guarantee beneficiaries receive the healthcare services to which they are entitled.
Mwangangi said the reforms are designed to strengthen accountability and improve service delivery under Kenya’s Universal Health Coverage programme.
The Authority advised facilities seeking clarification on the new reimbursement framework to contact SHA through its toll-free number or official communication channels.