Nairobi, Kenya- The Social Health Authority (SHA) has raised the bar in healthcare financing, announcing that it has mobilized Sh70 billion since its inception—far outpacing the now-defunct National Health Insurance Fund (NHIF), which collected Sh45 billion over its lifespan.
Speaking during an interview on Citizen TV, SHA Chief Executive Officer Mercy Mwangangi revealed that the inflows were spread across multiple funds: Sh8 billion for primary healthcare, Sh5.9 billion for the emergency and chronic illness fund, Sh54 billion under the Social Health Insurance Fund (SHIF), KSh4 billion from public servants, and another KSh500 million from indigenous sources.
But while the numbers are impressive, Mwangangi admitted that fraud remains a serious concern. Of the Sh80 billion in claims submitted by facilities nationwide, Sh10.7 billion has already been flagged and rejected.
Fraudulent Facilities Under Probe
To tighten oversight, SHA has forwarded a list of 1,118 health facilities to the Directorate of Criminal Investigations (DCI) for review. Investigations so far show that 85 facilities engaged in blatant fraud, while 151 were caught submitting false claims and operating outside their licensed categories of care.
“Our law is very clear. If you submit a fraudulent claim to SHA, there are contractual terms that govern what SHA would do, including fines and criminal prosecution,” Mwangangi warned.
She underscored that the audits are ongoing and more facilities may be flagged as the Authority continues combing through the backlog of claims.
Balancing Transparency and Patient Privacy
Mwangangi also addressed public concerns about the handling of patient data during fraud investigations.
She reassured Kenyans that SHA operates within the Data Protection Act and the Digital Health Act, which safeguard the confidentiality of medical information.
“The data that the DCI will have is governed by law. Patient consent is sought when claims are filed, and it’s impossible for SHA to verify legitimacy without accessing records,” she explained.
On the progress of enrolment, the SHA boss confirmed that 26 million Kenyans have signed up for the scheme.
Out of these, 4.8 million are active contributors, with 890,000 from the informal sector and 4 million salaried employees.
For Mwangangi, these numbers demonstrate both the demand and the scale of SHA’s mandate: to build a sustainable, accountable, and fraud-free healthcare financing model for Kenya.
