NAIROBI, Kenya – Health Cabinet Secretary Aden Duale has announced the formation of a joint committee with insurance industry leaders to combat fraud targeting the Social Health Authority (SHA), the government’s flagship universal health coverage scheme.
Speaking after a meeting with chief executives of major insurance companies at Afya House, Duale said the new Joint Anti-Fraud Action will curb malpractice in the sector while ensuring every Kenyan has access to affordable, quality healthcare.
“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 to expand access to affordable, quality healthcare for all Kenyans,” said Duale.
The CS also updated the executives on the ongoing Taifa Care reforms, anchored in key health laws, including the Social Health Insurance Act, Primary Health Care Act, Digital Health Act, Facility Improvement Financing Act, and the forthcoming Quality of Care and Patient Safety Bill.
Among the resolutions agreed at the meeting were:
- Private insurers to extend benefits beyond SHA’s packages and co-finance chronic care.
- Linking insurers to SHA’s digital claims platform to improve transparency and efficiency.
- Harmonising accreditation standards to guarantee uniform quality of care.
- Supporting the strengthening of the National Health Registry and regulating drug pricing.
Insurance executives also pledged support in addressing fraud, which has in recent months involved cases of biometric manipulation and bed-sharing scams by healthcare facilities, undermining the programme’s credibility.
Duale reaffirmed the ministry’s commitment to work closely with insurers, the Insurance Regulatory Authority (IRA), and SHA to tackle deep-rooted structural challenges.
“I reaffirmed the Ministry’s commitment to tackling structural challenges through legal, institutional and data-driven reforms, and called for a Public–Private Collaborative framework involving MoH, SHA, private insurers and IRA,” he said.
The SHA replaced the troubled National Health Insurance Fund (NHIF) in October 2024 after President William Ruto faulted NHIF for massive debts and inefficiencies that left Kenyans struggling with high out-of-pocket health costs.
Ruto had promised SHA would deliver a more accountable system, though recent fraud cases have sparked concerns about whether the new authority can overcome the challenges that plagued its predecessor.
