Health Cabinet Secretary Aden Duale has dismissed claims that Ksh11 billion was lost at the Social Health Authority (SHA), describing the reports as misleading and inaccurate.
Speaking on Friday, February 27, during an Assessment and Planning Retreat with senators, Duale moved to directly counter the narrative that billions had disappeared under the new health scheme. He stated unequivocally that there was no financial loss at SHA.
According to Duale, the figure in question — which he said currently stands at Ksh12.7 billion — represents rejected or unpaid claims flagged by the authority’s enhanced digital verification system. He explained that the system identified and blocked questionable submissions before payment could be processed.
“This figure currently stands at Ksh12.7 billion as of today, representing the claims that were flagged, that we rejected, and the claims that were unpaid by our digital superhighway gatekeeper,” Duale said.
He argued that under the now-defunct National Hospital Insurance Fund (NHIF) manual processing framework, some of these claims might have been approved and paid out without sufficient scrutiny. By contrast, SHA’s digital system is designed to detect irregularities, prevent fraud, and enhance accountability in the settlement process.
Duale pledged to provide senators with a detailed breakdown of the rejected Ksh12.7 billion, including how much originated from private hospitals and how much came from public health facilities. He indicated that some of the flagged claims were rejected on grounds such as suspected fraud, though he did not provide specifics during the session.
Beyond addressing the controversy, Duale also shared performance data on SHA’s rollout. As of late February 2026, he said, 29.7 million Kenyans had registered under the new health scheme. The authority had collected Ksh142.78 billion in contributions and disbursed Ksh105 billion to healthcare providers nationwide.
He further revealed that SHA is currently achieving an average claims settlement rate of 73 percent across all categories of providers, including private, public, and faith-based institutions. According to Duale, this reflects operational stability and improved efficiency compared to previous systems.
The CS’s remarks come amid heightened scrutiny of the transition from NHIF to SHA, with lawmakers and stakeholders closely monitoring financial controls, transparency, and service delivery under the new health financing model..
