SHA Makes Accredited HMIS Mandatory for All Healthcare Providers

Healthcare providers across the country risk losing their contracts with the Social Health Authority (SHA) after the agency declared the use of accredited Health Management Information Systems (HMIS) is mandatory for the 2026/28 contracting cycle.

In a notice issued on Tuesday, June 39, SHA CEO Mercy Mwangangi said all contracted and prospective healthcare providers must have a certified HMIS that meets the technical integration requirements prescribed by the authority and the Digital Health Agency (DHA).

"Healthcare providers that do not meet the prescribed HMIS requirements will not be eligible for contracting, contract renewal or continued participation in SHA-funded schemes during the FY 2026/28 contracting cycle."

According to the authority, healthcare providers will be required to remain electronically connected to SHA's Centralised Digital Platform to facilitate service verification, claims processing and information exchange.

The directive effectively requires all SHA-contracted healthcare providers to adopt accredited Health Management Information Systems integrated with the authority's digital platform, marking a major shift in the administration of the national health insurance scheme.

The move is intended to ensure uninterrupted service delivery while enhancing the efficiency and accountability of the country's digital health ecosystem.

Notably, the new requirement is anchored in both the SHA contract and the Digital Health Act, 2023, which obligate healthcare providers to maintain systems capable of collecting, processing, storing and retrieving beneficiaries' medical records.

A Health Management Information System (HMIS) is a digital platform used by hospitals, clinics and other healthcare facilities to manage patient records, treatment information, billing, appointments and other day-to-day medical services.

It replaces manual record-keeping by storing health information electronically.

Under the new requirements, every facility's health information system must comply with national digital health standards, integrate with the country's comprehensive health information system and adhere to the provisions of the Data Protection Act.

As per SHA's new directives, the HMIS used by healthcare providers must be certified by the Digital Health Agency before facilities can participate in the SHA programme.

SHA said the transition to accredited HMIS platforms will strengthen the detection of fraud, waste and abuse through data analytics while improving the accuracy and quality of claims submitted by healthcare providers.

The new system will is also expected to enable real-time verification of services offered to beneficiaries, speed up claims adjudication, improve provider performance monitoring and support better planning and sustainability across SHA funds.

To prepare for the new contracting cycle, healthcare providers have been directed to install approved HMIS systems, ensure they can connect to SHA and DHA platforms, train their staff on how to use them, fix any technical issues and take part in SHA training and onboarding programmes.

Healthcare providers who fail to comply with the prescribed HMIS requirements will be rendered ineligible for new contracts, contract renewals or continued participation in the SHA program.

"Within the next three months, I expect all providers to be fully integrated. If not, we will have no option but to decontract non-compliant facilities," Mwangangi said during a stakeholder meeting on Tuesday.