Duale blames fraud for EduAfya scheme collapse

Fraud, misuse, and double payments led to the discontinuation of Edu Afya programme, Health Cabinet Secretary Aden Duale has said.

Duale accused some hospitals of orchestrating fraudulent deals that led to the collapse of the EduAfya medical scheme, which had been providing comprehensive health cover to students in public secondary schools.

Speaking before the Senate, Duale cited widespread misuse and irregular payments under the scheme, initially rolled out in 2018 through the National Education Management Information System (NEMIS).

“There were several challenges that were found—fraud, misuse, double payments to health institutions arising from a single treatment. I can provide the names and institutions,” he said.

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The medical scheme, administered by NHIF, ran from May 1, 2018, and lapsed on December 31, 2023.

The CS explained that the programme was found to be unsustainable due to the irregularities, prompting the government to consolidate it under the Social Health Authority (SHA).

“The government resolved to re-consolidate all special schemes into one—the SHA benefit package. The consolidation of EduAfya with other NHIF schemes is geared towards implementing equity in attaining standard healthcare for all Kenyans,” he said.

Duale further said that under the new framework, every child would be entitled to healthcare services through their household's registration within the SHA system.

“Every child shall have a right to the highest attainable standard of health care in our country. Under SHA, children belong to the household and therefore are eligible to benefit from the three funds,” he noted.

He was responding to a question from Nairobi Senator Edwin Sifuna, who had sought clarification on why EduAfya had been discontinued under the current Social Health Insurance Fund.

“Why was the EduAfya medical scheme which provided comprehensive medical insurance to secondary learners under the National Insurance Fund was discontinued under the current Social Health Insurance Fund programme?” Sifuna questioned.

Duale also promised to ensure the transfer of payrolls and budgets for Universal Health Coverage (UHC) staff from the national government to county governments.

“Health is a devolved function. I will not violate the Constitution. This is part of our commitment to ensure every child, regardless of location, is protected from vaccine-preventable diseases,” he said.