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Uproar over downgrade of 100 rural private hospitals
Dr Brian Lishenga (centre), Chairman of the Rural and Urban Private Hospitals Association of Kenya (Rupha) leading his members in addressing journalists at Boulevard hotel in Nairobi on December 16, 2024.
The Rural and Urban Private Hospitals Association of Kenya (Rupha) has protested the downgrade of 100 hospitals in two counties, terming it irregular.
In a June 30, 2025 letter to the Chief Executive Officer of the Kenya Medical Practitioners and Dentists Council (KMPDC), David Kariuki, Rupha expressed concern that the facilities in Kisii and Nyamira have been downgraded from the Kenya Essential Health Facilities (KEPH) Level 3 to Level 2, despite having renewed their licences in January under the same categories now in question.
KEPH Level 2 facilities provide basic outpatient services such as immunisation, treatment of common illnesses, and referrals, and are typically staffed by nurses or clinical officers.
In contrast, Level 3 facilities—like health centres and nursing homes—offer a broader range of services including maternity care, minor surgeries, inpatient services, and laboratory diagnostics, with more advanced staffing and infrastructure.
Importantly, Level 3 facilities qualify for both the Primary Healthcare Fund (PHCF) and the Social Health Insurance Fund (SHIF), while Level 2 facilities are limited to PHCF support. PHCF is a component established under the Social Health Authority (SHA) and aims to ensure access to essential and affordable primary healthcare services by purchasing services from healthcare facilities and paying them for delivering quality care.
Rupha chairman Brian Lishenga argued that it is both improper and unfair for the KMPDC to accept payment for a specific facility category and then change it without explanation, adding that the affected facilities had not received inspection reports nor had they been allowed to address any shortcomings or request re-inspection, as set out in the joint health inspection checklist and risk rating table.
“It is our view that the recommended actions outlined in the checklist and risk rating framework were not followed,” he said, adding that such actions undermined transparency and eroded confidence in the regulatory system.
The downgrade of the 100 hospitals follows a major government-led crackdown last month, when the Cabinet Secretary for Health, Aden Duale, announced the downgrading of 301 health facilities and the closure of 728 non-compliant ones.
The crackdown, conducted jointly by SHA, the KMPDC, and the Digital Health Agency, was part of the wider implementation of the Universal Health Coverage programme under the Taifa Care initiative.
According to the KMPDC, facilities were downgraded because they failed to provide the full range of services they were registered to offer, citing insufficient medical supplies, non-functional equipment, and a shortage of qualified staff, including doctors, nurses, clinical officers, laboratory technicians, and pharmacists.
“These gaps meant they could not safely or effectively deliver the expected services at their designated level,” said Dr Kariuki.
However, Rupha now questions whether proper procedures were followed during the downgrading process.
“Typically, facilities should receive an inspection report and have the opportunity to apply for re-inspection if necessary. Moreover, each facility is supposed to be given a timeframe to address any issues before any drastic re-categorisation occurs,” said Dr Lishenga.
He warns that this action has directly impacted contractual relationships with the SHA. For instance, if a facility is downgraded from Level 3 to Level 2, it can no longer provide services under the SHIF and is limited to the PHCF. This effectively cuts off essential services such as maternity care and minor surgeries.
KMPDC has not provided any appeal mechanism for the affected health facilities, leaving them without a clear path for redress.
