The Social Health Authority (SHA) has launched a comprehensive nationwide training program for health facilities, marking a decisive step toward strengthening compliance and accountability in Kenya’s healthcare financing system.
The initiative, announced on Wednesday, August 27, 2025, comes in the wake of an extensive audit that exposed Ksh 10.6 billion in fraudulent or non-compliant claims, including cases of upcoding of services, phantom billing, and unnecessary treatments, malpractice that has long undermined the integrity of Kenya’s social health insurance framework.
SHA Chief Executive Dr. Mercy Mwangangi Officer said the training seeks to equip hospitals and clinics with practical tools to navigate the complex claims system, reduce unnecessary rejections, and safeguard public funds.
SHA Chief Executive Dr. Mercy Mwangangi Officer
“Training is a critical step in ensuring facilities understand the requirements for proper claims management and can avoid unnecessary rejections or delays,” Dr. Mwangangi stated. “We are committed to ensuring that providers are paid promptly for genuine services while protecting public resources from abuse.”
The program, branded as virtual “Provider Clinics,” runs until September 1 and is structured in phases to ensure targeted instruction for different facility levels. Level Four hospitals across all counties were scheduled for training on Thursday, followed by Level Three facilities on Friday, and Level Two facilities on Monday. Sessions will cover the entire claims journey from approvals and partial payments to rejections, surveillance referrals, and proper documentation.
To date, health facilities have submitted claims worth Ksh 91.7 billion under the Social Health Insurance Fund (SHIF) and the Primary Health Care (PHC) scheme. Of this, Ksh 60.7 billion has been paid, while Ksh 6.4 billion has been approved but is awaiting disbursement.
However, the audit flagged serious issues:
Ksh 10.6 billion rejected due to fraud or non-compliance,
Ksh 3 billion under re-evaluation because of missing documents, and
Ksh 2.1 billion flagged for surveillance and on-site verification.
Healthcare analysts say the findings indicates the urgency of SHA’s intervention. “SHA is drawing a line in the sand,” noted a Nairobi-based health policy expert. “By combining enforcement with training, they are making it clear that compliance is not optional.”
Dr. Mwangangi emphasized that the training is not solely punitive but also supportive, ensuring facilities have the knowledge and systems needed to comply effectively. Beyond financial rectitude, the Authority hopes that stronger claims management will free up resources for patient care, strengthen referral systems, and promote equitable access to health services.
