SHA Issues Notice to Health Providers Ahead of Nationwide Medical Scheme Talks

The Social Health Authority (SHA) has announced nationwide talks with contracted medical providers ahead of fresh agreements under the Public Officers Medical Scheme Fund. 

In a statement on Sunday, April 26, the agency said the talks will be held across the country to review key operational areas under the scheme. 

"The Social Health Authority informs all contracted Health Care Providers that it will conduct countrywide negotiations on the Public Officers Medical Scheme Fund from 28th April 2026, to agree on tariffs, service delivery arrangements, and claims management processes, in line with Clause 10.2(c) of the POMS Addendum," the statement read.

SHA said the move comes after consultations with several government agencies and workers’ unions involved in the scheme.

"The negotiations follow consensus reached through engagements with key stakeholders, including the State Department for Public Service, the Teachers Service Commission, the National Police Service, the Kenya Prisons Service, KNUT, KUPPET, and the Union of Kenya Civil Servants," the statement added.

The authority also directed hospitals and clinics currently serving members under the scheme not to impose extra charges while the talks continue. 

"During the negotiation period, contracted providers offering POMSF services should not charge beneficiaries out-of-pocket fees or co-payments," the statement continued. 

SHA further warned that facilities that fail to reach agreements after the negotiations risk losing their contracts.

"Upon conclusion of the negotiations, each provider will be required to sign the agreed tariffs. Providers with whom tariffs are not successfully agreed will be notified of the termination of the POMS contract immediately," the statement concluded.

This comes a day after the Ministry of Health announced a series of measures aimed at resolving operational challenges affecting healthcare delivery to civil servants, POMSF.

The changes, announced on Thursday, April 23, followed a consultative meeting involving representatives from the Ministry of Health, SHA, and the Union of Kenya Civil Servants (UKCS). 

In a joint statement, the parties first moved to assure civil servants that their medical cover has not been reduced despite the ongoing disruptions.

To address immediate challenges being experienced at hospitals, SHA announced changes to the system currently affecting service delivery.

"To alleviate the immediate friction at the point of care, SHA will immediately withdraw the tariff locking currently configured in the system," the statement added.

With the removal of tariff restrictions, the government emphasized that civil servants should not incur any additional costs while seeking treatment.

"Crucially, in this interim period following the withdrawal of the locked tariffs, all health facilities offering POMS services are strictly prohibited from charging any civil servant or public officer any out-of-pocket fees," the statement continued.

Officials further clarified that stricter tariff rules will remain on hold until ongoing discussions with healthcare providers are completed.

"Accordingly, the strict tariff applications contemplated under Clause 10.2(c) of the Addendum shall remain suspended and will only become active upon the successful conclusion of the nationwide negotiations," the statement clarified.

To support affected individuals, the government announced the immediate establishment of a rapid response mechanism.

"To address the plight of affected civil servants, SHA, the State Department for Public Service, and UKCS will immediately establish a Joint Rapid Response Desk," the statement noted.

The desk will intervene to secure the release of any civil servants detained in hospitals and will also review claims for refunds of unauthorized charges incurred during the disruption.

Further, the ministry warned healthcare providers against imposing unauthorized charges on civil servants.

"Any unauthorized charging of civil servants constitutes a material breach of contract and will attract swift enforcement action, including de-contracting," the statement read.

Civil servants were also advised to only seek treatment from approved facilities within the scheme to avoid exploitation.

"To protect beneficiaries from exploitation, services must be accessed exclusively through health facilities that are formally contracted under the SHA POMSF network. Private doctors or clinics not contracted under the scheme are not covered. SHA will continuously publish and update the comprehensive list of all contracted POMSF facilities on its official website to guide civil servants," the statement added.

Finally, the ministry emphasized stricter oversight measures to safeguard the sustainability of the fund.

"To protect the integrity of the medical fund, SHA will rigorously enforce approved cost-containment measures, including regular claims audits to detect fraud, quarterly utilization reviews, and continuous loss ratio monitoring. SHA will optimize the provider network, ensuring only facilities that adhere to clinical standards and negotiated pricing are contracted," the statement concluded.