NAIROBI, Kenya – The Social Health Authority (SHA) will no longer reimburse public hospitals for medicines that are prescribed but not issued to patients, in a major policy shift aimed at tightening accountability in Kenya’s healthcare system.
Health Cabinet Secretary Aden Duale announced the directive while appearing before the Senate, citing findings from the government’s Digital Health Superhighway.
The system flagged widespread inconsistencies in Level 4 and Level 5 hospitals, where patients reportedly complete consultations, lab tests, and even surgeries but leave without receiving prescribed drugs.
Under the new rule, SHA will settle payments for all other medical services but exclude the cost of medication if patients are not supplied with drugs at the hospital pharmacy.
Duale said the move is intended to seal loopholes that have allowed facilities to claim full reimbursements despite failing to provide complete care.
“We have established that patients are being forced to buy medicines outside hospitals, often from nearby private pharmacies,” Duale told senators. “Going forward, SHA will not pay for drugs that are not issued within the system.”
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The Cabinet Secretary cited Kakamega Provincial General Hospital as a key example, where over 52,000 patients reportedly went through treatment without receiving medication.
Similar trends have been observed in Nairobi and Bomet County, raising concerns about systemic inefficiencies and possible exploitation.
The Digital Health Superhighway, which integrates patient data, healthcare providers, and insurers into a unified platform, has enabled real-time monitoring of service delivery.
According to Duale, this has significantly improved transparency and exposed gaps in drug distribution across facilities.
To address the issue, the government is pushing hospitals to procure medicines through the Kenya Medical Supplies Authority, whose availability has improved in recent months. Kemsa currently boasts a 92 percent order fulfillment rate, with plans to reach full capacity by the end of the year.
The reforms come amid broader efforts to clean up the health sector. Duale revealed that over 1,200 facilities implicated in malpractice have been shut down, while dozens of medical practitioners have been barred from practice.
Additionally, the government has allocated Sh4 billion to settle pending claims inherited from the defunct National Hospital Insurance Fund, aiming to restore confidence among healthcare providers.
Beyond financing, the ministry is also investing in long-term healthcare improvements, including expanded cancer treatment capacity at Kenyatta National Hospital and the establishment of regional cancer centers across the country.
The new directive signals a firm push by the government to ensure patients receive full treatment within public facilities while curbing fraud and inefficiency in the health system.
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