Clueless Health CS: Barasa at pains to explain SHA bombshell

The Ministry of Health is facing growing scrutiny over the Social Health Authority (SHA) and the Social Health Insurance Fund (Shif), amid revelations that powerful individuals, rather than the government, control the scheme.

Despite the ministry’s authoritative position, its role appears to have been reduced to merely implementing directives in what is emerging as a well-crafted scheme benefiting a select few at the expense of millions of Kenyans.

On Wednesday, Health Cabinet Secretary Deborah Barasa seemed to rush through questions she was asked despite calling for the press to respond to concerns raised by Kenyans.

When asked about SHA’s ownership, Barasa sidestepped the question.

“I believe the president addressed that yesterday... the president addressed that yesterday,” she responded, offering no further clarification.

The controversy surrounding SHA and SHIF has escalated as health facilities continue turning away patients, citing non-payment by the government. The crisis has deepened public mistrust, with concerns that the Ministry of Health is now merely rubber-stamping a process that serves private interests.

“We are cognizant of the issues that were raised by the Auditor General, the ministry clarified and substantiated each issue and provided the management report to the AG, these issues have been comprehensively addressed by the accounting officer who is the PS Medical Services and they will be expounded more exhaustively in Parliament if given a chance,” said Barasa. 

Appearing before the Senate last week, Barasa came under blistering attack from senators who accused her of failing to explain glaring issues in the controversial scheme which has exposed patients to suffering.  

Busia Senator Okiya Omtatah opened the assault, asking Barasa how she reconciles the concept Universal Health Care and the practice of paying premiums.  “There is not a country in the world that has effectively implemented Universal Health Care that is funded through premiums but through taxes. Kenya is a signatory to the Abuja declaration, when did we turn away from this and make citizens pay for this,” said Omtatah.

Kisii Senator Richard Onyonka told the House that the CS appeared to be groping in the dark on issues being raised.

“I see the CS struggling…” said Onyonka adding, “Can I make a special request because I heard the Leader of Majority make a contribution and the Speaker did not pronounce himself. I believe that this matter cannot, maybe we need to have it in a committee……everything I hear here is just a confusion….Can we as the Senate ask the CS to go and prepare herself.

Kitui Senator Enock Wambua told the House, “I am completely underwhelmed by the responses from the CS, I want to join my colleagues in requesting the House that the CS makes arrangements to appear before a committee of the whole House”.

Five months ago, while appearing before the National Assembly’s Health Committee, the CS was caught off guard as MPs pressed her to explain the SHIF bands and remittances on live camera.

Mogotio MP Reuben Kiborek was overheard calling her “clueless” after she struggled to outline how the health insurance fund would function.

“The CS must explain things clearly to Kenyans. She cannot keep pledging to provide details later—how will the public understand?” one lawmaker lamented.

Gathungu bombshell

Another MP warned, “We don’t want this system to fail because someone isn’t doing their job.” Amid mounting pressure, it took the intervention of the SHA CEO Robert Ingasira to calm the situation.

Kenya faces a looming health crisis as private and mission hospitals threaten to halt services over unpaid bills totaling Sh30 billion, restricting treatment to emergency cases only.

“Patients seeking SHA or MAKL services at the point of service shall be informed that services are temporarily unavailable,” reads a section of the Rural Private Hospitals Association of Kenya (RUPHA) guidance notice.

Kenya’s Social Health Authority (SHA) oversees the Social Health Insurance Fund (SHIF), replacing NHIF under the 2023 Social Health Insurance Act.

Apeiro Ltd (59.5 per cent), Safaricom PLC (22.6 per cent), and Konvergenz Network Solutions (17.9 per cent) manage SHA’s technology platform. Six banks—KCB, Sidian, Co-op, Equity, Absa, and DTB—handle SHIF employer contributions. These firms support SHA’s transition and operations.

Barasa’s reluctance to comment followed a bombshell by Auditor General Nancy Gathungu,  who told Parliament that the SHA platform is privately owned. Appearing before the Senate County Public Accounts Committee, Gathungu disclosed that her audit confirmed the system does not belong to the government.

“I have pronounced myself on the audit report on Social Health Insurance Fund, where I have concluded that there was no effectiveness and lawfulness in the use of public resources,” Gathungu told lawmakers. “The matter is now squarely before Parliament to decide on what to do with it.”

Nairobi Senator Edwin Sifuna pushed for drastic action, questioning whether SHA and SHIF should be declared criminal enterprises. “Can we agree before this committee today that we are going to terminate SHA and SHIF and face the consequences in a court of arbitration since it seems not to benefit the citizens but only a few individuals?” he asked.

Homa Bay Senator Moses Kajwang echoed these concerns, insisting that Parliament must act decisively. “The Auditor General has made it clear that her reports are not complete until they are brought before Parliament, which must now prescribe a way forward,” he said. “I hope this issue of SHA does not fade away at the altar of political expediency.” The Auditor General’s office has identified five legal violations in the government’s establishment of SHA, intensifying public outrage. In its 2023-2024 report, the office flagged unbudgeted and non-competitive procurement, undefined scope of work, lack of agreements on payments, and unfavorable contract clauses as key flaws in the Social Health Insurance Fund.

A significant concern is the government’s decision to invest Sh104.9 billion in the Healthcare Information Technology Digitisation system without scrutinizing critical contract terms. According to Gathungu, state officials surrendered ownership and intellectual property rights of the system to a private entity, with contractual disputes required to be resolved under the London Court of International Arbitration.

The Ministry of Health has struggled to confirm whether it has any control over the system, exacerbating concerns about its transparency and accountability. Amid public outcry, SHA dismissed allegations that it maintains an escrow account where funds are transferred. However, lawmakers remain unconvinced, pointing to a lack of financial oversight in SHA’s operations.

Health experts have warned that the absence of a fallback system could compromise service delivery if the digital system fails. Meanwhile, reports indicate that health workers have not been adequately trained on SHA’s implementation, despite the government allocating Sh7 billion for the process.

Patrick Amoth, Director-General at the Ministry of Health, acknowledged these concerns, stating that the government is now working on a manual to train healthcare workers on the system’s usage. “Many times, when people visit health facilities, workers assisting them are unfamiliar with the system,” he said. “Instead of seeking help, they claim SHA is not working, simply because they don’t know how to use it.”

Amid the growing controversy, SHA Acting CEO Ingasira sought to reassure the public, stating that all SHIF contributions are collected through six banks—Equity, KCB, Cooperative Bank, Absa, Sidian, and Diamond Trust Bank—and an M-Pesa account registered under SHA.

“Collections for SHIF are handled through these commercial banks, and we reconcile our receipts with the banks daily,” Ingasira said. “I can assure you that not a single cent goes elsewhere. The only money leaving these accounts is used to pay hospitals.”

Despite these assurances, public trust in SHA remains low, with MPs close to the president and in Kenya Kwanza asking people to register.

Speaking in Embu, nominated Senator Karen Nyamu defended SHA and SHIF.

“Watu wa Embu mnapinga serikali sana... Msiniite harambee mkikataa kujiandikisha kwa SHA” (Embu people, why oppose the government? Don’t invite me for fundraisers if you’re not registered with SHA), she told residents.
SHA, which replaced NHIF under the Social Health Insurance Act 2023, introduced a 2.75% gross salary deduction. While promising efficiency, its privatized digital system raises oversight concerns, and higher deductions have fuelled public skepticism.