Health Cabinet Secretary Aden Duale has announced a new digital system aimed at stopping public doctors from treating patients in private clinics during the hours they are supposed to be working in government hospitals.
Speaking on Wednesday during the signing of an Intergovernmental Partnership Agreement (IPA) between the national government and county governments, Duale said the government will introduce an automated system that blocks insurance claims made through the Social Health Authority (SHA) if they are authorized during a doctor’s official working hours in a public hospital
According to the CS, the system will track the time when doctors approve treatment claims from their private facilities. If the claim is made at a time when the doctor is expected to be on duty at a public hospital, the SHA will automatically reject it.
“We are going to put in a digital system where if you are supposed to be working in a county hospital from 8am to 5pm and a claim from your private clinic is sent during that time, SHA will not pay it,” Duale said.
He explained that all claims must go through a pre-authorisation process before payment is made. Since doctors are the ones who authorise these claims, the system will capture the exact time and location of the approval.
Under the new plan, any claim made by a doctor’s private clinic during the hours they are expected to serve in a county referral hospital will be declined automatically.
Duale gave an example of doctors who leave public hospitals during lunch hours to attend to patients in their private clinics.
“If you work in a county referral hospital from 8am to 5pm and you go to treat a patient in your clinic during lunchtime, that claim will not be paid because SHA only pays after the doctor authorises it,” he said.
The CS added that the system will also track doctors working night shifts. Any claim authorised while a doctor is scheduled to be on duty in a public facility will still be flagged.
According to Duale, a new system is in the process of being introduced to enhance the patient waiting experience in public facilities. The move is part of a series of measures aimed at protecting public health funds and improving the quality of care in government health facilities.
The move comes at a time when the Social Health Authority is under scrutiny over allegations of fraud, with claims of over KSh11 billion in suspicious claims.
In the same ceremony, the national and county governments signed a memorandum aimed at improving collaboration in providing health services in the country. The move is a boost to the Building Resilient and Responsive Health Systems (BREHS) project, a five-year program that kicked off in January 2025 and is set to conclude in June 2029.
The project seeks to improve access to primary health care and health systems in all 47 counties in the country.