Duale, Insurers Form Joint Committee to Fight Health Sector Fraud
Health Cabinet Secretary (CS) Aden Duale has unveiled plans to establish a joint committee with insurance company CEOs to curb fraud within the Social Health Authority (SHA).
Speaking after a meeting with the insurers at Afya House, Duale said the committee will help safeguard the integrity of the health system while ensuring Kenyans access affordable, quality healthcare.
“We agreed to set up 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,” he stated.
The CS also updated the executives on the ongoing Taifa Care reforms, anchored on 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—all central to advancing Universal Health Coverage (UHC).
Key Resolutions
Some of the resolutions from the meeting include:
- Private insurers extending benefits beyond SHA’s packages and co-financing chronic care.
- Integration of insurers into SHA’s digital claims platform to boost transparency and efficiency.
- Harmonization of accreditation processes to standardize quality of care.
The insurance CEOs further pushed for strengthening the National Health Registry and creating a framework to regulate drug pricing.
Duale reaffirmed the Ministry’s commitment to tackling systemic challenges through legal, institutional, and data-driven reforms, calling for a Public–Private Collaborative Framework involving the Ministry of Health, SHA, private insurers, and the Insurance Regulatory Authority (IRA).
Background
SHA was launched on October 1, 2024, replacing the debt-ridden National Health Insurance Fund (NHIF).
President William Ruto said NHIF had accumulated billions in debt and failed to align contributions with the real cost of healthcare. He assured Kenyans that SHA would eliminate the inefficiencies that plagued NHIF.
However, despite reforms, the sector continues to face hurdles, including biometric-related fraud and bed-sharing schemes in health facilities—challenges that have left many Kenyans struggling to access services.
