When Aden Duale, Kenya’s Cabinet Secretary for Health, sat down with the heads of the country’s leading insurance firms this week, the message was clear: fraud in the Social Health Authority (SHA) system must end.
Speaking after the meeting at Afya House in Nairobi, Mr Duale announced the formation of a new anti-fraud committee that will bring together his ministry, the SHA, and private insurers. The goal, he said, is to safeguard public funds while making healthcare more affordable and accessible.
“We agreed to establish a Joint Anti-Fraud Action to crack down on malpractice in the sector and strengthen collaboration with the Social Health Authority,” Mr Duale told reporters. “Our priority is to expand access to affordable, quality healthcare for all Kenyans.”
The SHA, launched in October last year to replace the scandal-hit National Health Insurance Fund (NHIF), was meant to be a fresh start for Kenya’s long-struggling healthcare system. President William Ruto said the old NHIF had collapsed under billions in debt and mismanagement. Yet SHA has quickly faced its own problems, including reports of fraudulent biometric claims and facilities billing for services never offered.
The new committee, Mr Duale explained, will focus on several key areas. Insurers will be asked to extend benefits beyond SHA’s current packages and to co-finance care for patients with chronic illnesses. A central digital claims platform will be created to reduce fraud and improve efficiency. Accreditation standards will also be harmonised so that care remains consistent across hospitals and clinics.
Insurance executives who attended the meeting called for further reforms. They urged the government to strengthen the National Health Registry and introduce controls on drug pricing, saying high costs were pushing more families into financial hardship.
Mr Duale said the reforms would be underpinned by new laws, including the Social Health Insurance Act and the Primary Health Care Act. He also highlighted forthcoming legislation on quality of care and patient safety.
“I reaffirmed the Ministry’s commitment to tackling structural challenges through legal, institutional and data-driven reforms,” he said, adding that only strong collaboration between government and the private sector could achieve the dream of Universal Health Coverage.
The committee’s creation comes at a time when confidence in public healthcare is fragile. For many Kenyans, the promise of SHA was that it would succeed where NHIF failed. But with fraud and inefficiency once again making headlines, Mr Duale’s new initiative may be the government’s last chance to prove that health insurance can truly work for the people.
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