Private hospitals warn of health crisis after removal of maternity services in Level 2 and 3 facilities
Maternal and neonatal deaths could surge in Kenya following the removal of maternity and inpatient services from Level 2 and 3 health facilities, private hospitals have warned.
The changes, implemented through the Social Health Authority (SHA) provider portal administered by the Digital Health Agency (DHA), eliminated maternity and inpatient bed allocations for all Level 2 hospitals, including those with functional maternity units, and for Level 3 facilities that do not operate theatres.
The Rural and Urban Private Hospitals Association of Kenya (RUPHA) now warns that pregnant women, especially in poor and remote areas, could be locked out of essential healthcare services.
In a letter dated July 29, 2025, addressed to Director General of Health Dr Patrick Amoth, RUPHA urged the Ministry of Health to reinstate these services in affected facilities, warning that the country risks undoing recent healthcare gains.
“We recommend that your office urgently advise Health Cabinet Secretary Aden Duale on the impact of removing maternity and inpatient bed capacity from Level 2 and 3 facilities. This affects access to essential services, worsens maternity and neonatal outcomes and increases out-of-pocket costs for poor households,” reads the letter.
RUPHA also accused the Kenya Medical Practitioners and Dentists Council (KMPDC) of unlawfully reclassifying hospitals in June and July, contributing to the service disruptions.
The association urged Amoth to issue a technical advisory to KMPDC, DHA and SHA to clarify the range of services allowed at Level 2 and 3 facilities, particularly in relation to maternity, immunisation and inpatient care.
According to RUPHA, the SHA portal changes have led to the elimination of 1,278 maternity beds from Level 2 facilities and 2,200 from Level 3B institutions, amounting to a total loss of 3,478 maternity beds. This represents an estimated 18.6 per cent of the country’s total maternity bed capacity.
“It also means that 1,080 delivery beds have been removed, about 28.6 per cent of the national total,” RUPHA Chairman Brian Lishenga said.
He added that the reclassification, reportedly directed by Afya House and enforced by KMPDC, downgraded 1,138 Level 3B inpatient facilities, resulting in the removal of up to 10,000 inpatient beds.
These figures, Lishenga said, are supported by findings from the 2023 Kenya Health Facility Census.
“The removal of maternity and inpatient services from Level 2 and 3B health facilities will hinder access to essential care, leading to poor maternal and neonatal outcomes and rising out-of-pocket costs for low-income households,” he warned.
The affected facilities are often the first and only points of care in underserved communities. Without SHA support, hospitals are no longer reimbursed for delivery services, meaning pregnant women are now expected to pay cash out of pocket.
RUPHA warned that the new financial burden on patients could limit access to quality healthcare and lead to higher maternal and infant mortality rates.
According to data from the Ministry of Health, most deliveries in Kenya occur in Level 2 and 3 institutions, including dispensaries and health centres, making the SHA policy changes even more detrimental.
Counties in northern Kenya, such as Mandera, Turkana, Wajir, Garissa, and Marsabit, along with urban informal settlements, are especially vulnerable, as these facilities are often the only providers of maternity services in those areas.
RUPHA asked Amoth to guide KMPDC to activate the Kenyan Essential Package for Health (KEPH) Level 3C classification, ensuring that facilities offering inpatient care without theatre services are not unfairly downgraded, and that their capacities are fully reflected in licensing and contracting decisions.
The association further called on the Ministry to reaffirm the vital role of dispensaries and health centres in providing maternity and immunisation services, especially amid budget cuts.
“We wish to highlight that the 2025/26 national budget enacted cuts to the recurrent budgets of KMPDC, the Clinical Officers Council, and the Nursing Council of Kenya,” reads the letter.
The facilities urged Amoth, as a top technical advisor in the Health Ministry, to act swiftly to prevent the erosion of progress made in maternal and neonatal healthcare across the country.
The changes, implemented through the Social Health Authority (SHA) provider portal administered by the Digital Health Agency (DHA), eliminated maternity and inpatient bed allocations for all Level 2 hospitals, including those with functional maternity units, and for Level 3 facilities that do not operate theatres.
The Rural and Urban Private Hospitals Association of Kenya (RUPHA) now warns that pregnant women, especially in poor and remote areas, could be locked out of essential healthcare services.
In a letter dated July 29, 2025, addressed to Director General of Health Dr Patrick Amoth, RUPHA urged the Ministry of Health to reinstate these services in affected facilities, warning that the country risks undoing recent healthcare gains.
“We recommend that your office urgently advise Health Cabinet Secretary Aden Duale on the impact of removing maternity and inpatient bed capacity from Level 2 and 3 facilities. This affects access to essential services, worsens maternity and neonatal outcomes and increases out-of-pocket costs for poor households,” reads the letter.
RUPHA also accused the Kenya Medical Practitioners and Dentists Council (KMPDC) of unlawfully reclassifying hospitals in June and July, contributing to the service disruptions.
The association urged Amoth to issue a technical advisory to KMPDC, DHA and SHA to clarify the range of services allowed at Level 2 and 3 facilities, particularly in relation to maternity, immunisation and inpatient care.
According to RUPHA, the SHA portal changes have led to the elimination of 1,278 maternity beds from Level 2 facilities and 2,200 from Level 3B institutions, amounting to a total loss of 3,478 maternity beds. This represents an estimated 18.6 per cent of the country’s total maternity bed capacity.
“It also means that 1,080 delivery beds have been removed, about 28.6 per cent of the national total,” RUPHA Chairman Brian Lishenga said.
He added that the reclassification, reportedly directed by Afya House and enforced by KMPDC, downgraded 1,138 Level 3B inpatient facilities, resulting in the removal of up to 10,000 inpatient beds.
These figures, Lishenga said, are supported by findings from the 2023 Kenya Health Facility Census.
“The removal of maternity and inpatient services from Level 2 and 3B health facilities will hinder access to essential care, leading to poor maternal and neonatal outcomes and rising out-of-pocket costs for low-income households,” he warned.
The affected facilities are often the first and only points of care in underserved communities. Without SHA support, hospitals are no longer reimbursed for delivery services, meaning pregnant women are now expected to pay cash out of pocket.
RUPHA warned that the new financial burden on patients could limit access to quality healthcare and lead to higher maternal and infant mortality rates.
According to data from the Ministry of Health, most deliveries in Kenya occur in Level 2 and 3 institutions, including dispensaries and health centres, making the SHA policy changes even more detrimental.
Counties in northern Kenya, such as Mandera, Turkana, Wajir, Garissa, and Marsabit, along with urban informal settlements, are especially vulnerable, as these facilities are often the only providers of maternity services in those areas.
RUPHA asked Amoth to guide KMPDC to activate the Kenyan Essential Package for Health (KEPH) Level 3C classification, ensuring that facilities offering inpatient care without theatre services are not unfairly downgraded, and that their capacities are fully reflected in licensing and contracting decisions.
The association further called on the Ministry to reaffirm the vital role of dispensaries and health centres in providing maternity and immunisation services, especially amid budget cuts.
“We wish to highlight that the 2025/26 national budget enacted cuts to the recurrent budgets of KMPDC, the Clinical Officers Council, and the Nursing Council of Kenya,” reads the letter.
The facilities urged Amoth, as a top technical advisor in the Health Ministry, to act swiftly to prevent the erosion of progress made in maternal and neonatal healthcare across the country.
level 2 hospital
Rupha
Rural and Urban Private Hospital Association
level 3 hospitals
RUPHA Chairperson Brian Lishenga
maternity services
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