Government Cracks Down on Hospitals in 5 Counties Over SHA Fraud

Health Cabinet Secretary Aden Duale has revealed the government has flagged five counties, Mandera, Kisii, Bungoma, Homa Bay, and Wajir, as hotspots of alleged fraud linked to Social Health Authority (SHA) claims.

Speaking before a Senate plenary session on April 22, Duale said the government would not relent on the crackdown, noting that most of the alleged fraudulent activities were being carried out in private health facilities.

“Let me say it clearly, we have flagged five counties, Mandera, Kisii, Migori, Homabay, and Wajir, and we will not relent on this. Even the facilities. The majority of the fraud is being done in the private hospitals.  When I close a hospital, let me tell the leaders here, don’t call me,” Duale said.

Duale Reports Drop in SHA Fraud as Crackdown Intensifies

He warned that hospitals found to be involved would be closed, adding that political leaders should not intervene once enforcement action is taken against such facilities.

Duale reiterated that the crackdown has already taken effect, citing the closure of Bungoma West Hospital in Bungoma County, as well as the suspension of 12 other hospitals from SHA services.

The CS said the Director of Public Prosecutions (DPP) has already received at least 24 files related to SHA fraud, while the Directorate of Criminal Investigations (DCI) is handling more than 81 active case files.

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Duale noted that since April last year, when he assumed office at the Ministry, fraud levels had dropped from 26 percent to below 6 percent following enforcement actions.

He added that more than 1,200 health facilities had been shut down over non-compliance and fraudulent activity.

Duale further told the MPs that some of the cases forwarded to the DPP include two former chief executives who have already been taken to court.

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Health CS Clarifies Health Coverage for Pupils Following EduAfya Discontinuation

During the proceedings, lawmakers sought clarification on the status of the former EduAfya medical scheme and how pupils and students are currently covered following its discontinuation.

In response, Health CS Duale said the EduAfya program was initially government-funded but left behind significant unpaid obligations during the transition, which were not fully settled by the State.

He explained that the scheme has since been restructured, with children now covered as dependents under their parents’ health insurance arrangements.

According to Duale, pupils and students can access outpatient services at any health facility, with the costs fully covered by the government.

Duale further stated that, under the new arrangement, coverage for specialized treatment extends up to age 25, with parents expected to support their children within the broader dependents’ health cover framework.