The Ministry of Health has reached a landmark agreement with medical insurance companies to strengthen collaboration in expanding healthcare access and fighting fraud in the sector. The meeting, held at Afya House, brought together top government officials and chief executives from leading insurance firms to chart a way forward in bridging financial gaps and restoring public confidence in Kenya’s healthcare system.
The discussions centred on aligning insurance packages with the Social Health Authority (SHA) framework, while also providing additional services such as overseas care, elective procedures, premium add-ons, and co-financing of chronic care. These measures are intended to complement the SHA’s Emergency, Chronic, and Critical Illness Fund (ECCIF), ensuring broader coverage for citizens regardless of age or economic status.
A major highlight of the talks was the adoption of joint anti-fraud initiatives. Participants agreed on biometric verification for patients, joint audits across providers, and the creation of a shared database to track and eliminate fraudulent claims. This is expected to address long-standing concerns over ghost patients, negligence, and double billing, while improving transparency in service delivery.
The ministry also emphasized the importance of integrating insurers into SHA’s centralized claims platform. This move will enable real-time verification, quicker processing, and better protection against billing malpractices, in line with the Digital Health Act (2023) and the Data Protection Act (2019).
Further reforms outlined include the harmonization of accreditation criteria so that all Kenyans whether under SHA or private insurance schemes receive healthcare under uniform standards. Insurers called on the government to strengthen the National Health Registry to serve as a standardized, accessible platform for healthcare information. They also urged the establishment of a regulatory framework on drug pricing to promote transparency and accountability in the pharmaceutical sector.
In addition, the Ministry reaffirmed its commitment to reforms anchored in new legislation, including the Social Health Insurance Act, Primary Health Care Act, Digital Health Act, and Facility Improvement Financing Act. A forthcoming Quality of Care and Patient Safety Bill is also expected to enhance oversight and improve service standards.
Going forward, stakeholders agreed to build a public–private collaborative framework involving the Ministry of Health, SHA, the Association of Private Insurers, and the Insurance Regulatory Authority. The framework will focus on tariff alignment, data sharing, and eliminating fraud to advance Kenya’s Universal Health Coverage (UHC) goals.
