'I can't resign!' Health CS Duale says amid alleged Ksh.11B loss at SHA

The Ministry of Health has been on the spot again following revelations that billions of shillings may have been siphoned in just six months through fictitious surgeries and suspicious medical claims, despite assurances that SHA had sealed loopholes that plagued the defunct National Health Insurance Fund (NHIF).

Speaking during an interview on Citizen TV's JKLive show, CS Duale pushed back against the loss claims but did not directly address whether any amount had indeed been lost, instead focusing on the rejected claims. 

“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,” he said.

Duale framed the issue as evidence that the system was working rather than failing, arguing that fraud detection mechanisms had identified and blocked suspicious payouts before money left the system. 

However, he repeatedly sidestepped direct questions on how much money was lost in fraudulent claims, maintaining that only about Ksh.1 billion had been paid after a meticulous process. 

Addressing the long-standing public perception of corruption at the Ministry of Health headquarters, Duale reaffirmed that his ministry had streamlined the sector to enhance 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: impeaching me by Parliament; the criminal justice system dealing with me if I have integrity issues; I'm a political appointee, the President can one morning say I need another minister for Health,” he said.

Further, he described insurance fraud as a global challenge, saying Kenya was not unique.

“Rejection and fraud in the insurance industry are global problems and we are not exceptional. Digitization is the key to insurance fraud. The digital health system detects patterns," Duale stated.

"The fraudulent characters who were working with the insiders within the insurance authority migrated to SHA. Little did they know that we have the SHA as one entity and we have the Digital Health Agency, another separate entity, but working together."

The CS also pointed to ongoing reforms and uptake of new products under SHA, citing that 420,000 Kenyans had enrolled in the SHA Lipa pole pole program and paid Ksh.1.4 billion to access specialized treatment. 

Duale’s remarks also come amid disclosures he made to Members of Parliament during a retreat in Naivasha, where his presentation unearthed a trend where health facilities siphoned money from the systems. 

In his address, the CS outlined what he described as a worrying trend in which expectant mothers were allegedly pushed into undergoing surgical deliveries to inflate insurance claims.

He said some facilities were carrying out unnecessary procedures, with several of the Caesarean Section (CS) claims flagged as suspicious. 

“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,” said the Health CS.

“We have one facility that told us they are doing C-sections, and when I visited it had no theatre, which had 35 claims of CS."

The revelations formed part of the broader public debate over whether SHA is truly working as intended or simply uncovering problems after public funds are already at risk.