Fraud Threatens Kenya’s Healthcare System

Kenya’s push for Universal Health Coverage (UHC) faces a major challenge: rising fraud within the newly established Social Health Authority (SHA). Health Cabinet Secretary Aden Duale has stepped in with a bold strategy, announcing a joint committee with insurance CEOs to combat malpractice that threatens to derail healthcare reforms.

Duale underscored that fighting fraud is not just about protecting resources but about ensuring every Kenyan has access to affordable, safe, and reliable medical care.

The Anti-Fraud Committee’s Role

The committee is designed as a collaborative platform bringing together the Ministry of Health, the Social Health Authority, private insurers, and regulators. Among its top priorities are:

• -Expanding insurer benefits beyond SHA’s current packages.

• -Co-financing chronic care to ease costs for patients.

• -Linking insurers to SHA’s digital claims system to boost efficiency.

• -Harmonizing accreditation to guarantee uniform care standards.

Insurers also pushed for drug price regulation and strengthening the National Health Registry—critical moves to improve accountability and service delivery.

Tackling Structural Challenges

Kenya’s health sector has long struggled with gaps in funding, weak oversight, and rampant fraud. Duale reaffirmed his ministry’s commitment to tackling these challenges through legislative and institutional reforms. Key initiatives include the Social Health Insurance Act, Primary Health Care Act, Digital Health Act, and Facility Improvement Financing Act—all pillars of the healthcare transformation.

An upcoming Quality of Care and Patient Safety Bill is also expected to set tougher standards for facilities, making sure patients get safer and more effective care.

SHA Replaces NHIF’s Troubled Legacy

The Social Health Authority, rolled out in October 2024, replaced the collapsed National Health Insurance Fund (NHIF), which had been riddled with corruption and inefficiencies. Billions of shillings were lost, while patients faced unequal access to care.

President William Ruto promised SHA would solve these problems, but new threats have already emerged, including biometric fraud and hospital-level scams like bed-sharing. Duale’s anti-fraud measures are aimed at restoring confidence and protecting SHA from following NHIF’s troubled path.

Collaboration to Secure UHC

The fight against fraud highlights the need for stronger partnerships between the government and private insurers. By creating a united framework, Kenya’s healthcare sector could become more transparent, efficient, and reliable.

Duale stressed that protecting SHA is central to delivering on the promise of UHC. For millions of Kenyans, this reform is not just about policies—it’s about securing their right to quality healthcare.