Health Cabinet Secretary Aden Duale has dismissed claims by former Deputy President Rigathi Gachagua that the Social Health Authority SHA is embroiled in a KSh 104 billion fraud scandal, describing the allegations as misleading and politically motivated.
Gachagua alleged that the government inflated the cost of the new health scheme from KSh 1 billion to KSh 104 billion, warning that the programme risks collapsing amid operational challenges. He also claimed the scheme had reduced benefits for teachers and other public servants.
Duale said the KSh 104 billion figure represents a 10 year service agreement with a consortium led by Safaricom. He explained that payments are based on a usage model funded through member contributions rather than a one off expenditure.
The Health CS added that the arrangement has been upheld by the High Court, reinforcing its legality and transparency.
The Social Health Authority, which replaced the National Hospital Insurance Fund NHIF in October 2024, has enrolled more than 30 million Kenyans. It has collected KSh 169 billion in contributions and disbursed KSh 125 billion for claims, according to official data.
Coverage expansion and accountability
Duale said the scheme has expanded access to healthcare for teachers, police officers and other civil servants. Inpatient cover for teachers ranges from KSh 1 million to KSh 3 million, while outpatient services are capped at KSh 450,000 annually.
He rejected claims that teachers are limited to KSh 1,200 daily, saying the benefits remain comprehensive and that changes mainly target accountability in the use of public funds.
Beneficiaries can now access more than 6,000 health facilities nationwide, up from about 600 under the previous system. The government has also introduced digital tools to improve service delivery.
Duale urged members to download the Afya Yangu app to check benefits, balances and nearby hospitals.
He said some criticism is driven by facilities affected by anti fraud measures, warning that the government will not reverse efforts to eliminate irregular claims.
Gachagua, speaking in Murang’a County, maintained that the SHA is struggling to deliver services effectively. He claimed some teachers face difficulties accessing care and raised concerns about costs not fully covered.
Stakeholders have also pointed to delays in claims processing and gaps in chronic illness coverage as areas that need improvement.
Despite the concerns, the government says the transition from NHIF to SHA is necessary to achieve universal health coverage and improve efficiency through digitisation.
Duale said reforms are ongoing and urged the public to rely on verified information as the government works to strengthen the healthcare system.
