Health Cabinet Secretary Aden Duale has rejected claims that Ksh.11 billion was lost through fraud under the Social Health Authority, saying the money never left the system and that strict controls are now in place to protect public health funds.
He argues that what is being presented as a loss is in fact proof that fraud detection systems are working by identifying and blocking suspicious claims before payment.
The Ministry of Health has recently come under pressure following reports that billions of shillings may have been targeted through fictitious surgeries and questionable medical claims within a short period of time.
These reports raised alarm because the Social Health Authority was created to fix the weaknesses that existed under the defunct National Health Insurance Fund.
Many Kenyans expected the new system to completely shut out fraud, leading to sharp reactions when the allegations emerged.
Speaking during an interview on Citizen TV’s JKLive show, Duale dismissed the suggestion that the country had lost Ksh.11 billion. Instead, he emphasized that the ministry had rejected fraudulent claims worth Ksh.11.6 billion.
He said the system was able to detect suspicious activity and stop it in time, ensuring that contributors’ money was not stolen.
“As of this evening, we have rejected Ksh.11.6 billion fraudulent claims. Every coin of a Kenyan he has paid for his healthcare insurance, if you steal it, the system will detect you, flag you and the government will prosecute you,” Duale said.
While pushing back against the loss claims, the CS did not give a direct answer on whether any money had been lost at all.
He maintained that only about Ksh.1 billion had been paid out after undergoing a careful verification process.
According to him, this amount followed strict checks and could not be compared to the rejected claims.
Duale also addressed the long-standing perception that corruption was deeply rooted at the Ministry of Health headquarters. He acknowledged that when he first took office, there were issues that fed this reputation.
However, he said changes had since been made to improve accountability and support the goal of universal health coverage.
“When I went there, that time I denied it. After three weeks, I realized there was some truth about why Kenyans called it Mafia House, but today it is Afya House. Why should I resign. I don’t need to resign. If I commit anything contrary to my oath of office, there are various ways of dealing with me,” he said, listing Parliament, the justice system, and the President as avenues for accountability.
The Health CS further noted that insurance fraud is not unique to Kenya and is a global problem. He explained that digitization plays a key role in detecting fraud, as digital systems can identify unusual patterns and flag them early.
He added that those who previously exploited the old system tried to move to SHA without realizing that checks had been strengthened through cooperation between SHA and the Digital Health Agency.
Duale also highlighted progress under the new system, noting that about 420,000 Kenyans have enrolled in the SHA Lipa Pole Pole program and paid Ksh.1.4 billion to access specialized treatment.
He presented this as a sign of growing public trust.
During a separate retreat with Members of Parliament in Naivasha, Duale revealed troubling trends involving some health facilities. He said some facilities were inflating claims by pushing expectant mothers into unnecessary surgical deliveries.
“Somebody wants to force a mother to a C-section when she can deliver normally just because they want to get a difference of Ksh.20,000,” he said.
He also cited a case where a facility claimed to perform Caesarean sections despite lacking a functional theatre.
These revelations have fueled a wider debate on whether the Social Health Authority is fully safeguarding public funds or simply exposing problems before more damage is done.
