SHA's HMIS Explained: Why Health Facilities Got Until 30 October to Switch

Kenya's health facilities now have until 30 October to finish moving onto a new digital system that links patient care to the checks and payments of the Social Health Authority (SHA), the body that runs the country's social health insurance.

Health Cabinet Secretary Aden Duale announced the extra month on 1 October, one day after the first deadline, and the Ministry of Health says patients will keep getting care at facilities that have not finished.

The extension covers public Level 5 and 6 facilities, which are the county and national referral hospitals, faith-based facilities, meaning those run by religious groups, and private health facilities.

The system is called the Health Management Information System, or HMIS.

From bedside to bill

HMIS is digital health software that hospitals and other facilities use to manage patient records, treatment details and billing, as Kenyans.co.ke described it in its report on SHA's notice to providers.

The Ministry says the SHA version will check on the spot that a patient is covered, handle claims electronically, confirm that the facility sending a claim is genuine, and let compliant systems exchange health information securely, according to People Daily.

The aim is to link what happens to a patient in a facility with the records SHA uses to pay for that care.

SHA manages the money and the contracts with facilities.

The Digital Health Agency is the government body that certifies health software.

The Provider Portal was SHA's earlier platform for claims, which facilities are now leaving, and HMIS is the system that takes its place for claims.

Two roads onto the system

Kenya sorts public facilities into levels by size, from small dispensaries at Level 2 and health centres at Level 3 to sub-county hospitals at Level 4, county referral hospitals at Level 5 and national referral hospitals at Level 6, such as Kenyatta National Hospital in Nairobi, the capital.

Public facilities are being moved onto Taifa Care HMIS, the government's own version.

The Star wrote that SHA announced at the end of June that Level 4 hospital claims would go through it from then on, after testing and approval by SHA and the Digital Health Agency, and that claims already sent through the portal stay in the system and will still be processed.

Private facilities that run their own software must have it certified, meaning officially approved, by the agency under the Digital Health Act.

The Ministry says 28 such systems have been certified so far, People Daily noted, though the reports of the statement do not give the total number of private systems, so how many remain is unclear.

How far the move has gone

By the Ministry's count, all 6,427 public facilities from dispensaries to sub-county hospitals have finished the move.

Among Level 5 hospitals, four have finished and 23 are at various stages, as People Daily set out the Ministry's figures.

Of 518 contracted faith-based facilities that the government is helping to install the system, 38 have fully finished, which is fewer than one in ten, Duale said in a passage Kahawatungu quoted from the statement.

Kenyatta National Hospital and Kenyatta University Teaching, Referral and Research Hospital are expected to finish by the end of next week, according to The Star's account, while the other Level 6 facilities have until 30 October.

The Digital Health Agency will run technical support drives with private facilities through October, and the Ministry was due to meet health sector associations on 2 October to agree facility by facility plans.

The case for going digital

Kenyans.co.ke's account of SHA's end of June notice lists the aims as strengthening detection of fraud, waste and abuse through data checks, improving the accuracy of claims, confirming services as they happen, speeding up decisions on claims and tracking how each facility performs.

Citizen Digital's 29 September story described the system as meant to address problems that dogged the old portal, namely late payments, weak patient checks and claims fraud, and said the Digital Health Agency promises to cut fraud and speed up payments.

These are stated aims, and the sources used here report no results yet.

Eastleigh Voice wrote in September that SHA's new contracting framework responds to complaints from the first contracting cycle, which ran from 2024 to 2026, including payment delays, rejected claims and unreliable systems.

The move also has a legal basis.

SHA's contract and the Digital Health Act of 2023 require facilities to keep systems that can collect, process, store and retrieve the medical records of beneficiaries, the people covered by SHA, according to Kenyans.co.ke.

SHA said the systems must also follow the Data Protection Act, the law on handling personal information.

In late June, SHA chief executive Mercy Mwangangi told a stakeholder meeting that SHA would end contracts with facilities not fully connected within three months, the same report said.

What patients are being told

People Daily's explainer says HMIS does not replace SHA, because SHA finances health care and HMIS links treatment records and claims to it.

The same piece says SHA contributions continue.

"Patients will continue to receive services at all health facilities during this transition period," the Ministry of Health said in its 1 October statement, as Kahawatungu quoted it.

People Daily added that 30 October is a deadline for facilities, not for patients seeking care.

Duale said on 29 September that doctors can view a patient's records, including scans, across facilities without the patient carrying them, Citizen Digital wrote.

A month with two clocks

The Star's 29 September story has Duale saying facilities had to move by 30 September or risk being locked out of SHA, and Citizen Digital quoted him saying facilities that had not moved could not serve patients.

The Ministry's 1 October statement then gave the extra month.

A second deadline sits inside it.

Mwangangi pushed the deadline for renewing contracts back by 14 days to 14 October and said no further extension would follow, according to The Star's 1 October story.

Facilities accepting the extension, which they must sign and return within three days, keep working under their current contracts, and services to SHA members continue only at those facilities.

Facilities that decline have been asked to work with SHA county managers to move patients to contracted facilities.

SHA will also run contracting clinics, which are help sessions for facilities finishing their papers, in every county from 5 October.

Reports of the Ministry's statement do not say what happens to a facility that misses 30 October. For now, the public facilities at Levels 2 to 4 are on the system, and the remaining facilities have until the end of the month to join them.