Health Cabinet Secretary Aden Duale has dismissed reports claiming that the Social Health Authority (SHA) lost Sh50 billion, describing the figures cited in a local newspaper as misrepresented and misleading. Duale explained that the alleged “losses” arose from a misunderstanding of statutory accounting rules and transitional financial processes during the shift from the now-defunct National Hospital Insurance Fund (NHIF) to SHA. In a detailed statement, the CS clarified that amounts flagged as suspicious payments were in fact legally authorised benefits, routine bank transfers, and standard accounting estimates.
To categorically set the record straight: no billions have been lost or misappropriated. The figures being summed up represent standard accounting provisions and legally sound payments, not missing cash
CS DualeAmong the figures highlighted, the report mentioned a Sh1.3 billion “irregular transfer” and Sh3.3 billion “untraced” from the Social Health Insurance Fund (SHIF) to SHA. Duale rejected this, noting that SHA is the statutory authority tasked with managing these funds, making such transfers routine and legally required.
Accounting for Outstanding Claims
The report also referenced Sh26.8 billion in “unsupported claims”. Duale clarified that this represents an Outstanding Claims Reserve, which includes Incurred But Not Reported (IBNR) claims, money set aside to cover hospital bills for treatments already provided but not yet submitted for audit.
The Sh26.8 billion is responsibly set aside to pay hospitals for patients treated but not yet processed in the system. Under IFRS 17, failing to reserve such funds would itself be unlawful,
CS DualePayments for Authorized Services
Another disputed figure of Sh7.3 billion, allegedly for “unauthorised services,” was explained as payments under the Public Officers Medical Scheme Fund (POMSF), which provides enhanced coverage for teachers and civil servants beyond the standard SHIF package. The discrepancies arose because the services were assessed using SHIF rules rather than the specific POMSF framework.
Similarly, Sh1.56 billion flagged as payments to “uncontracted facilities” occurred during the transition period in October 2024, when hospitals previously contracted under NHIF continued treating patients while SHA digital contracts were processed. Only Sh92.4 million in genuine contracting anomalies led to immediate suspension of payments.
Automated Corrections Prevent Overpayments
For claims involving Sh2.4 million in alleged overpayments, Duale explained that the SHA digital claims system automatically corrects clerical input errors to match legally prescribed government tariff rates, ensuring compliance and fairness.
Duale urged media houses to report responsibly on complex financial and insurance accounting processes, warning that sensational claims could mislead the public amid what he described as the largest health financing transition in Kenya’s history.
Responsible reporting requires that all facts are presented objectively and that headlines reflect the true substance of the story, rather than driving unwarranted pani
CS Duale 