The government has reiterated its commitment to streamlining the Social Health Authority (SHA) systems to curb fraud while enhancing access to affordable healthcare services for more than 29 million registered Kenyans.
Health Cabinet Secretary Adan Duale said the government had lost approximately Sh11 billion between October 2024 and April last year through fraudulent and fictitious claims lodged by healthcare facilities during the transition to the SHA system.
Addressing Members of Parliament in Naivasha during the ongoing 2026 Legislative Retreat, Duale revealed that 1,118 healthcare facilities across the country had so far been closed after being implicated in defrauding public funds through the SHA platform.
“The government has commenced investigations into the Sh11 billion syphoned through the SHA system between October 2024 and April last year through fake claims, unprocedural surgeries, ghost patients and collusion,” said Duale.
He noted that most of the fraud occurred during the SHA transition period, adding that investigations were ongoing to hold accountable all facilities and officials involved in the corruption scheme.
Duale warned that the government would not hesitate to shut down more facilities found engaging in fraudulent practices, noting that private healthcare facilities topped the list of offenders, followed by county hospitals and national referral hospitals.
So far, the CS said, over 29 million Kenyans had registered under the SHA programme, with more than Sh130 billion collected in contributions and Sh93.3 billion disbursed to healthcare facilities for services rendered.
He expressed concern over fraudulent claims under maternity care, particularly where facilities claimed higher reimbursements for Caesarean section deliveries, which attract Sh30,000, compared to normal deliveries reimbursed at Sh10,000.
“We have noted a section of facilities that spiked their claims to as high as 97 per cent Caesarean section deliveries due to higher monetary benefits, as opposed to normal deliveries,” Duale said.
To address the challenge, the CS said the Ministry had adopted an Artificial Intelligence (AI)-driven fraud detection system to promptly identify anomalies within the SHA platform.
He added that over 10,000 healthcare facilities had been digitised, with 30,087 digital devices deployed to support efficient service delivery and enhance accountability.
In a bid to increase contributions among low-income earners, Duale said the government had introduced the SHA Lipa Pole Pole payment model, which had so far enrolled 412,011 active members who had contributed more than Sh1.4 billion.
Additionally, he said more than 558,000 vulnerable households were being supported by the national government, alongside 63,461 households receiving assistance through the National Government Constituencies Development Fund (NG-CDF).
The CS further disclosed that the government had established partnerships with 36 overseas medical facilities to cater for medical evacuation services, with funding capped at Sh500,000 per case for emergency procedures not available in local hospitals.
Duale also sought parliamentary support to address a Sh5.9 billion budgetary deficit affecting primary healthcare facilities, noting that the funds would be used to offset unpaid dues owed to facilities over the past three months to ensure uninterrupted service delivery.
In addition, the CS hailed a new partnership with the United States Government that would see direct support of about Sh210 billion annually to the Kenyan government for combating malaria, HIV/AIDS and tuberculosis, shifting away from the previous NGO-led funding model.
On reforms at the Kenya Medical Supplies Authority (KEMSA), Duale said measures already undertaken had increased drug availability in health facilities to 91 per cent, with further reforms aimed at supporting local manufacturing of medical products.
Under the National Equipment Support Project, he said the government had invested Sh6.18 billion across 120 county facilities and six national hospitals to provide modern medical equipment, ensuring Kenyans access quality healthcare closer to home.
To settle pending debts under the defunct National Hospital Insurance Fund (NHIF), Duale sought MPs’ support for a Sh5.3 billion allocation to clear claims of up to Sh10 million and an additional Sh27 billion for claims exceeding Sh10 million.
On his part, Director General for Health Dr Patrick Amoth said the Ministry had drafted a code of conduct for medical personnel that would hold practitioners personally liable for professional misconduct.
Amoth noted that Caesarean section deliveries were projected to reach 30 per cent, translating to about eight million cases, underscoring the need for strict oversight to prevent fictitious claims and unethical practices.
He added that the Ministry would review the health benefits package in October this year to ensure reimbursements were commensurate with the actual cost of care.
Gilgil MP Martha Wangari observed that some facilities had exploited Caesarean deliveries, warning that the rate could hit 30 per cent by 2030 if unchecked.
She urged the Ministry to approve claims only in cases of medically complicated deliveries and welcomed the proposed code of conduct, saying it would help hold healthcare officials accountable for negligence leading to patient deaths.
Nyeri MP Duncan Mathenge called for increased budgetary allocations to cater for cancer treatment, mental health services and rehabilitation care, noting that current funding was inadequate.
South Mugirango MP Silvanus Osoro urged the government to fast-track prosecution of individuals involved in defrauding SHA funds through fictitious claims.
By Erastus Gichohi
