The Ministry of Health is working with private insurance companies and other partners to close funding gaps in the health sector, fight fraud, and ensure every Kenyan has access to affordable and quality healthcare.
Health Cabinet Secretary Aden Duale on Monday met with Chief Executive Officers of major medical insurance firms at Afya House, Nairobi. The goal was to explore areas of collaboration with the Social Health Authority (SHA) as the country rolls out the new Taifa Care reforms under the Universal Health Coverage (UHC) plan.
The meeting focused on eliminating fraud in the health system, especially cases involving ghost patients and fake claims that cost Kenyans billions of shillings every year. They agreed to adopt joint anti-fraud measures such as biometric verification of patients, shared audit systems, and a common database of blacklisted healthcare providers.
CS Duale updated the insurers on the reforms backed by the new health laws — including the Social Health Insurance Act, Primary Health Care Act, Digital Health Act, and Facility Improvement Financing Act — which are designed to regulate service quality and expand healthcare access nationwide.
Health insurers agreed to support the SHA by offering complementary health packages not fully covered by the Taifa Care scheme, such as overseas treatment, specialized surgeries, and other premium services. They also discussed co-financing chronic illness treatment through the Emergency, Chronic and Critical Illness Fund.
To ensure transparency and prevent fraud, both the Ministry and insurers will work toward linking claims systems so that data can be shared and verified in real-time. They also discussed harmonizing hospital accreditation standards so that all Kenyans receive quality healthcare regardless of whether they are covered by SHA or a private insurer.
The insurance CEOs urged the government to speed up the development of a national health registry and to introduce a clear regulatory framework on medicine pricing to stop price manipulation and ensure fairness across the sector.
CS Duale said that while the health sector still faces structural weaknesses, the government is determined to fix them through new laws, better data, and partnership with the private sector. He called for a joint framework involving the Ministry, SHA, the insurance industry, and the Insurance Regulatory Authority (IRA) to align tariffs, share data, and root out fraud together.
The ministry recently suspended 40 hospitals from the Social Health Authority (SHA) programme, for engaging in fraudulent practices.
According to the CS, the suspension will not be lifted until the facilities comply with all SHA regulations.
“Therefore, the Social Health Authority has suspended these health facilities found to have engaged in corruption and theft of public resources,” the CS announced.
Duale also explained that during the period of investigations, the hospitals are not entitled to receive any benefits from SHA adding that the government will recover any money paid to the facilities based on fraudulent claims.
”Furthermore, we will be surcharging them to recover any money already paid to them on the basis of any fraudulent claims,” Duale further said.
Email your news TIPS to Editor@Kahawatungu.com — this is our only official communication channel
