SHA says full payment for medicines now tied to complete dispensing

SHA says full payment for medicines now tied to complete dispensing
SHA says full payment for medicines now tied to complete dispensing - Health CS Aden Duale, alongside Ministry of Health officials at the Kenyatta University Teaching, Research and Referral Hospital on August 4, 2025. (Photo: MoH)
Health CS Aden Duale, alongside Ministry of Health officials at the Kenyatta University Teaching, Research and Referral Hospital on August 4, 2025. (Photo: MoH)

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The authority said it had identified gaps in medicine dispensing in some contracted facilities, prompting the new measures.

Contracted primary healthcare facilities will now receive full payment for medicines only if they dispense all prescribed drugs to patients, under a new reimbursement model introduced by the Social Health Authority (SHA).
In a public notice, SHA said the new payment model is aimed at improving accountability and ensuring beneficiaries under the Primary Healthcare (PHC) Fund receive the full package of care, including prescribed medicines.
The authority said it had identified gaps in medicine dispensing in some contracted facilities, prompting the new measures.

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"SHA has identified gaps in medicine dispensing in some facilities, resulting in beneficiaries receiving only part of the care covered under the PHC package. To strengthen accountability, SHA will monitor each facility's medicine-dispensing rate through the Digital Health Agency platform and reimburse for the service given," read the notice.
SHA said the PHC benefit package covers the complete episode of care in line with the Ministry of Health treatment guidelines, including consultation, diagnosis, clinically indicated investigations, treatment and prescribed medicines.
Under the new model, SHA will continue determining each facility's monthly entitlement using the existing weighted global budget capitation model. A fixed portion of the payment will be allocated to medicines, while the remainder will cater for consultations, staff time, diagnostics, consumables, overheads and other service delivery costs.

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Explaining how the reimbursement will work, the authority said: "If the facility dispenses 100 per cent of prescribed medicines, it receives the full medicine payment. If it dispenses 80 per cent, it receives 80 per cent of the medicine payment, while the remaining 20 per cent is deducted. The non-medicine portion of the payment is not affected."
SHA said the new model is intended to reward facilities that consistently provide medicines to patients.
"This approach rewards facilities that consistently dispense prescribed medicines while ensuring payments reflect the actual level of service provided," said SHA.
The authority urged all contracted primary healthcare facilities to comply with the new requirements.
"SHA therefore expects all contracted PHC facilities to provide and accurately record the complete package of care, including prescribed medicines, to ensure beneficiaries receive the services to which they are entitled," SHA stated.

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