Kenya’s Principal Secretary for Medical Services, Dr Ouma Oluga, has sounded the alarm over what he calls “fraudulent practices” by some health facilities contracted under the country’s new insurance scheme.
In a candid interview with local media, Dr Oluga described how clinics and hospitals have been exploiting loopholes in the Social Health Authority (SHA) system, which manages the Social Health Insurance Fund (SHIF).
“These are facilities that set themselves up, get licensed, then move equipment to other branches. Six months later, they can’t provide the services they promised, yet they keep receiving payments,” he said.
According to Dr Oluga, the schemes often begin with genuine-looking facilities. Inspectors from the Ministry of Health visit and issue licences after confirming the equipment is in place. But within months, crucial machines are relocated to new branches. Patients then find services like maternity care missing, even though SHA continues to reimburse the hospital.
“It’s not that the inspectors were wrong,” he explained. “The problem is that when the machines or beds are moved, the facility no longer delivers the services it registered for. Yet SHA’s system still contracts them.”
The financial impact is significant. Some facilities, he noted, have received millions of shillings for treatments never provided.
To stop the fraud, the ministry has set up a 24-hour call centre where patients can file complaints directly. The system, he said, has already exposed hospitals falsely claiming to provide maternity services.
“We check and find the hospital removed the bed it registered with. At that point, we send in the regulator. Once confirmed, the facility is struck off the SHA system,” Dr Oluga said.
The revelations come as SHA faces wider criticism over alleged corruption and mismanagement in its early months. Reports of payments to ghost clinics have raised concerns about whether the insurance scheme can deliver on its promise of accessible healthcare for all Kenyans.
Dr Oluga insists reforms are under way. “We are committed to ensuring SHA works for wananchi, not for fraudsters,” he said.
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