Speaking during a Wednesday interview with a local station, Duale argued that the new authority’s effectiveness is being overshadowed by sensational media coverage that focuses on teething problems rather than concrete achievements in protecting public funds.

“Screaming headlines sell; if you say SHA is working, it will not sell, but screaming headlines will get out of the shell,” the CS said, adding that the detection and rejection of billions in questionable claims demonstrates the system is functioning as designed.

According to Duale, the bulk of the rejected claims emerged during the critical transition phase from the National Hospital Insurance Fund (NHIF) to SHA—a period that demanded heightened vigilance and robust verification mechanisms.

The CS disclosed that most flagged claims originated from health facilities and were subjected to rigorous multi-stage scrutiny before being declined.

“Facilities made claims amounting to about Sh11 billion. Most of these were fraudulent claims. The system picked them up, went through different validation and clinical reviews, and we are not paying,” Duale explained.

He emphasized that each claim undergoes automated validation, clinical reviews, and additional system checks to ensure compliance with established standards before any payment is authorized.

The Health CS issued a stern warning to facilities attempting to exploit the health insurance system, stressing that every shilling contributed by Kenyans is now under strict surveillance.

“Every coin that a Kenyan has paid for health care insurance, if it is stolen, the system will detect it, flag it, and the government will prosecute,” Duale stated firmly.

On Sunday, the CS had outlined the rigorous due diligence processes now mandatory for all claims, including forensic audits and clinical reviews to verify that billed services were actually delivered to patients.

“We will only pay after we do due diligence. SHA will conduct forensic audits and clinical reviews to make sure that the services offered are appropriate and that the Kenyan patient has actually received them,” he said.

While Duale celebrates the fraud detection success, some hospitals have raised concerns about delayed payments, arguing that the enhanced scrutiny is affecting their cash flow and operations.

The CS, however, maintained that facilities complaining loudest are primarily those whose claims remain under verification due to red flags raised during the review process.

He insisted the government is operating within legal parameters and that the thorough vetting is essential to safeguarding the integrity of Kenya’s health insurance system and protecting contributors’ funds from exploitation.

Duale’s remarks signal the government’s determination to ensure SHA operates with greater accountability than its predecessor, even as stakeholders navigate the challenges of implementing sweeping health sector reforms.

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Speaking during an induction meeting for newly appointed members of the Council of Governors (CoG) Health Committee, county chiefs raised concerns that the current framework undermines devolved health functions and exposes counties to penalties for circumstances beyond their control.

Among the clauses flagged is the requirement that counties remit statutory deductions to the Social Health Authority by the 9th of every month, failure to which they face penalties.

Governors argue this provision is unfair since the national government often delays disbursement of funds from the Exchequer.

“It is unfair to punish counties for late remittances when the national government has not released funds. We cannot pay what we don’t have,” said Tharaka Nithi Governor Muthomi Njuki, who serves as the CoG Whip.

“There should be flexibility in the timelines to account for Exchequer delays.”

According to the law, the National Treasury is required to disburse county allocations by the 15th of every month, but governors said this rarely happens.

They noted that delays have left counties struggling to meet their obligations, sometimes resorting to bank overdrafts.

The Chairperson of the Health Committee, Mombasa Governor Abdulswamad Shariff Nassir, said the council would be proposing specific amendments in the coming days to address the gaps observed during the initial implementation of the new social health system.

“We have identified clauses that need to be revisited. The Council will be presenting proposals to make the law more practical and responsive to county realities,” said Nassir.

Governors also took issue with the planned rollout of ambulatory services, likening the proposed model to digital taxi operations.

They warned that without clear coordination, the move could render existing county-owned ambulances obsolete.

“We must be part of the process of vetting and standardizing ambulances that will operate in our regions,” said Mandera Governor Mohammed Khalif.

“Counties already have ambulances, and any parallel system must complement, not compete with, them.”

Another concern raised by the governors is the deterioration of services at Level 2 facilities, where expectant mothers are reportedly unable to access essential maternal health services.

“We are getting worrying reports that some mothers are dying in these facilities, and others can no longer give birth at Level 2 hospitals as provided,” said Baringo Governor Benjamin Cheboi.

“This deprives counties and citizens of over KSh 2.6 billion meant for maternal health.”

CoG CEO Mary Mwiti emphasized that the council will continue engaging both the Ministry of Health and the National Treasury to ensure equitable health financing and a balanced rollout of the new insurance framework.

“Counties cannot continue carrying the burden of national policy gaps. We must have an inclusive approach,” Mwiti said.

The governors want the proposed changes finalized before December 10, ahead of a scheduled Summit meeting with President William Ruto, where they plan to push for adjustments in the implementation timelines and funding structures.

Council Health Director Khatra Ali echoed the need for collaboration between both levels of government, noting that donor withdrawal from the health sector has worsened the resource strain.

“We must rethink health financing comprehensively. With many donors pulling out, the two levels of government must find a sustainable model,” she said.

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