In a prime-time television interview that left Kenyans talking, Health Cabinet Secretary Aden Duale pushed back hard against reports that the country lost KSh 11 billion to fraudulent insurance claims under the Social Health Authority (SHA).
Speaking on Citizen TV’s JKLive, Duale did not confirm whether any funds were stolen. Instead, he reframed the narrative: the detection of massive fraud is proof the new system is working—not failing.
“As of this evening, we have rejected KSh 11.6 billion in fraudulent claims,” Duale declared. “Every coin a Kenyan pays for health insurance is protected. If you steal it, the system will detect you, flag you, and the government will prosecute you.”
So, was money lost?
The CS repeatedly sidestepped direct questions on actual losses. He maintained only about KSh 1 billion had been paid out after “meticulous” verification, framing the KSh 11.6 billion as claims that were blocked—not cash lost.
From “Mafia House” to “Afya House”?
Duale admitted there was once truth to the public’s grim nickname for the Ministry of Health headquarters.
“When I went there, after three weeks, I realized there was some truth to why Kenyans called it Mafia House,” he said. “But today, it is Afya House.”
When asked if he’d consider resigning over the scandal, his response was defiant: “Why should I resign? If I commit anything contrary to my oath, there are ways to deal with me—impeachment, criminal justice, or the President can replace me.”
A global problem, a digital solution
Duale emphasized that insurance fraud is a worldwide issue, not unique to Kenya. He credited digitization as the key weapon.
“The digital health system detects patterns. The fraudulent characters who worked with insiders in the old NHIF tried to migrate to SHA. Little did they know we now have the Digital Health Agency as a separate entity watching the watchers,” he explained.
SHA reforms showing results?
The CS pointed to ongoing reforms, noting that 420,000 Kenyans have enrolled in SHA’s Lipa Pole Pole program, contributing KSh 1.4 billion for specialized treatments.
The shocking fraud tactics exposed
In a related presentation to MPs in Naivasha, Duale revealed even more alarming trends:
- Forced C-sections: Some facilities push mothers into surgical deliveries just to inflate claims by KSh 20,000.
- Ghost surgeries: One flagged facility had 35 claims for Caesarean sections—but no operating theater.
The big question remains:
Is SHA successfully preventing fraud, or is it only uncovering losses after public funds are already at risk? Duale insists it’s the former, but with billions in claims flagged, the public and Parliament are demanding clearer answers on what—if anything—has already been stolen.
