Nairobi, January 28- Kenya’s healthcare sector is under scrutiny following revelations that about Sh11 billion was lost through fraudulent claims at the Social Health Authority (SHA), the body that replaced NHIF and oversees universal health coverage.
An audit by the Ministry of Health uncovered widespread abuse of the claims system, mainly involving private health facilities. Some hospitals allegedly inflated bills, claimed for services not provided, upgraded outpatient visits to inpatient admissions, and submitted fake records to receive higher payouts. In extreme cases, facilities reportedly billed for surgeries that never took place and falsely classified all deliveries as caesarean sections.
Health Cabinet Secretary Aden Duale described the fraud as a serious betrayal of public trust. More than 1,000 case files have been forwarded to investigators, with several facilities suspended, healthcare workers locked out of the SHA system, and multiple cases already before the courts.
The scandal has sparked public outrage and political debate, with leaders and citizens questioning accountability and the effectiveness of safeguards within the new health insurance system. President William Ruto has vowed to crack down on those responsible and recover stolen funds, insisting that stealing from healthcare resources amounts to stealing from sick Kenyans.
Beyond the financial loss, the scandal has raised concerns about the future of universal health coverage, as billions meant to improve access to healthcare were diverted through fraud. The government says new digital controls and audits have been introduced to prevent similar losses, but many Kenyans are calling for deeper reforms and full accountability.
