The government has rolled out a Joint Anti-Fraud Action to eliminate ghost patients, penalise malpractice, and restore public trust.
The Ministry of Health is also engaging strategic partners to bridge the financial gap in the health sector, and insurers have come on board to collaborate on the key issues affecting implementation of Taifa Care.
In a strategic meeting with Chief Executive Officers (CEOs) of medical insurance companies held at the Ministry of Health headquarters in Nairobi and chaired by Cabinet Secretary Adan Duale to explore areas of partnership, especially on the Social Health Authority (SHA), parties struck an accord that entailed complementary coverage, shared claims and data, and aligned empanelment standards.
“We aim at expanding access to quality and affordable healthcare for all Kenyans, regardless of age or economic status, and under the complementary coverage, the parties agreed that health insurers will supplement the Social Health Authority package,” Duale said.
This will include overseas care, elective procedures, premium add-ons, and co-financing of chronic care in addition to the SHA emergency chronic and critical illness fund.
The meeting similarly deliberated on the modalities of linking health insurers to the SHA centralised claims platform to facilitate real-time verification, enhanced processing, and prevention of multiple billing as per the Digital Health Act 2023 and Data Protection Act 2019.
Also settled upon was the harmonisation of accreditation criteria to enable the public to access quality care equitably.
The insurers requested the Ministry’s support in strengthening the National Health Registry to provide a standardised and accessible platform for healthcare information and the establishment of a regulatory framework for drug pricing to enhance transparency, accountability, and integrity in the sector.
CS Duale acknowledged structural challenges facing the health system, noting that the ministry is addressing them through laws and data-backed reforms to restore public trust.
He called for a public-private collaborative framework between MoH, SHA, the Association of Private Insurers, and IRA—starting with tariff alignment, data sharing, and fraud elimination.
Present at the meeting were Medical Services Principal Secretary Dr Ouma Oluga, SHA Chief Executive Officer Dr Mercy Mwangangi, her Digital Health Authority counterpart Eng. Anthony Lenayara, and Dr David Kariuki (CEO, KMPDC), together with industry leaders including Njeri Njomo (CEO, Jubilee Health Insurance), Justine Kosgey (CEO, AAR Insurance), and Japeth Ogalloh (CEO, Old Mutual), among others.
By Wangari Ndirangu
