The Social Health Authority (SHA) has collected more than Ksh70 billion since its establishment, but officials say the fund has also had to reject claims worth over Ksh10 billion due to fraud.
SHA chief executive Dr. Mercy Mwangangi revealed the figures during an interview on Citizen TV on Tuesday, contrasting the authority’s performance with that of its predecessor, the defunct National Health Insurance Fund (NHIF), which she said had only managed Ksh45 billion in its lifetime.
Collections Breakdown
Dr. Mwangangi detailed how the inflows were distributed across the new system:
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Ksh8 billion into primary health care
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Ksh5.9 billion into the emergency and chronic illness fund
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Ksh54 billion into the Social Health Insurance Fund
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Ksh4 billion from public servants
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Ksh500 million from indigenous sources
So far, 26 million Kenyans have registered with SHA, including 4.8 million active contributors—4 million salaried employees and 890,000 from the informal sector.
The authority disclosed that it had dismissed Ksh10.7 billion out of Ksh80 billion in claims submitted by facilities nationwide. Many, Dr. Mwangangi said, were found to be fraudulent.
“Our law is very clear,” she said. “If you submit a fraudulent claim to SHA, there are contractual terms that govern what SHA would do, including fines and criminal prosecution.”
The authority has already forwarded a list of 1,118 health facilities suspected of fraud to the Directorate of Criminal Investigations (DCI). Out of these, investigations revealed that 85 facilities were directly implicated, while 151 others were flagged for either operating outside their licensed tier of care or submitting false claims.
The revelations come as Kenyans adjust to the new social health insurance model, which replaced the controversial NHIF earlier this year. While the scheme has been praised for broadening access to health care, concerns remain about accountability and data privacy.
On the issue of patient confidentiality, Dr. Mwangangi maintained that SHA was compliant with existing laws.
“The data that the DCI will have is governed by the Data Protection Act and the Digital Health Act, which protect patient data. It’s within the law,” she said.
She defended the authority’s need to review patient records when verifying claims. “There’s no way we will know if the claim is legitimate if we can’t access the claim and determine it took place,” she said. “How would SHA pay, on trust? We can’t.”
Public Confidence at Stake
Analysts say the registration figures point to growing public acceptance of the new health model. However, they caution that persistent fraud and inefficiency could erode trust in a system designed to make healthcare more affordable and accessible.
For now, SHA faces the dual challenge of expanding coverage while safeguarding integrity in the use of public funds.
