CS Duale Orders Refunds, Warns Hospitals Against Illegal SHA Charges on Civil Servants

CS Duale Orders Refunds, Warns Hospitals Against Illegal SHA Charges on Civil Servants

NAIROBI, Kenya — Health Cabinet Secretary Adan Duale has issued a stern warning to hospitals across the country, directing them to immediately refund civil servants who have been unlawfully charged for medical services already covered under the Social Health Authority (SHA) package.

The directive, announced during the nationwide rollout of SHA services in Nairobi on June 10, signals a tougher enforcement approach by the Ministry of Health as the government seeks to eliminate unauthorized medical charges and restore confidence in the country’s new healthcare financing system.

In his address, Duale warned that health facilities found demanding out-of-pocket payments from public officers for services fully covered under SHA would face severe consequences, including immediate suspension from the scheme and possible closure.

“Any facility demanding unauthorised cash from our public officers for services covered under the approved package will face immediate suspension and be compelled to issue full refunds,” Duale declared.

The Cabinet Secretary emphasized that the government would no longer tolerate what he described as unlawful co-payments that have left some civil servants paying additional costs despite being enrolled in the government-backed healthcare programme.

The announcement comes amid growing complaints from public servants who have reported being asked to make extra payments at some hospitals despite the services being listed under SHA coverage.

According to Duale, the Ministry of Health and the Social Health Authority have now finalized in-service tariffs and reimbursement contracts with participating healthcare providers, creating a clearer framework for payments and reducing disputes over covered services.

“Through the execution of these contracts, SHA now has a clear reimbursement framework, and we will hold providers accountable to agreed rates, pre-authorisation requirements, and clinical standards,” he said.

Health officials say the new agreements establish firm guidelines governing how hospitals are reimbursed for services offered to SHA beneficiaries. The framework also strengthens accountability by requiring healthcare providers to adhere to agreed treatment costs and approval procedures.

The CS noted that beyond protecting patients from exploitation, the reforms are designed to safeguard public healthcare funds from misuse, fraud, and inefficiencies that have historically plagued medical insurance programmes.

As part of broader reforms, SHA has expanded its biometric registration programme to include dependents aged between seven and 17 years. The move is expected to improve beneficiary verification and reduce cases of identity fraud within the healthcare system.

The biometric registration system replaces the previous One-Time Password (OTP) verification process and introduces fingerprint and facial recognition technology for real-time identity authentication.

Under the upgraded system, patients can access services without presenting physical cards or paperwork. Instead, healthcare workers verify beneficiaries electronically before treatment is approved or claims are processed.

The Ministry says the new technology is being supported through the Practice 360 App, a geo-fenced digital platform used by healthcare workers to manage approvals and patient verification.

Officials believe the innovation will significantly reduce paperwork, speed up service delivery, and improve transparency in claims processing across healthcare facilities nationwide.

The biometric programme is already operational in all contracted Level 4, Level 5, and Level 6 hospitals, with the government now accelerating its rollout to Level 2 and Level 3 health facilities across the country.

According to Ministry of Health data, more than 25 million Kenyans have already been registered under SHA, making it one of the largest healthcare databases in the region.

The government views the programme as a cornerstone of its Universal Health Coverage agenda, aimed at ensuring all Kenyans have access to affordable and quality healthcare services regardless of their income levels.

“The era of illegal charges and unauthorized co-payments is coming to an end. Every Kenyan deserves fair access to healthcare under the SHA programme,” Duale said.

The latest warning is expected to increase scrutiny of healthcare providers while reassuring public servants and other SHA beneficiaries that the government is moving aggressively to enforce compliance and protect patients from unlawful medical charges.

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‘CS Duale Orders Refunds, Warns Hospitals Against Illegal SHA Charges on Civil Servants