The Social Health Authority (SHA) and the Digital Health Agency (DHA) have assured Kenyans that healthcare claims and payments under the Taifa Care programme continue to be processed in line with the law, dismissing concerns raised over the management of the country’s digital claims system.
In a joint statement, the two institutions said the healthcare financing system remains operational and compliant with the Social Health Insurance Act, 2023, despite recent media reports questioning the role of private firms in processing claims.
SHA Clarifies Roles in Claims Processing            Â
The agencies stressed that no private company receives, controls, or pays out funds meant for hospitals on behalf of SHA.
According to the statement, SHA is solely responsible for receiving, reviewing, approving and paying eligible claims submitted by contracted healthcare providers.
DHA, on the other hand, provides the digital infrastructure that enables hospitals and health facilities to submit and process claims electronically and securely.
The clarification comes as Kenya continues implementing its digital health transformation agenda under Taifa Care, which seeks to improve efficiency, accountability, secure patient verification and faster claims processing across the healthcare system.
Digital Platform Supports Healthcare Delivery
SHA explained that the Taifa Care system operates on integrated digital platforms developed under a government contract with the Safaricom Consortium.
The contract also permits the engagement of specialised subcontractors where necessary, in accordance with Kenya’s procurement and contracting laws. The authority further addressed concerns surrounding the 2% service fee linked to the digital platform.
It said the charge is provided for under the Digital Health Act, 2023, and related regulations. The fee supports electronic claims processing, patient verification, secure sharing of health information across healthcare facilities, and automation of administrative processes.
SHA noted that the system reduces paperwork, manual processing and delays while lowering administrative costs for healthcare providers. It added that the fee only applies to claims that have already been approved for payment.
Commitment to Transparency
The authority urged healthcare facilities to submit complete and accurate claims documentation, obtain required pre-authorisations where applicable, and ensure banking details are up to date to facilitate timely payments.
SHA also said it continues to support healthcare providers through training, technical assistance and ongoing system improvements aimed at reducing claim delays and rejections.
Both SHA and DHA reaffirmed their commitment to transparency, accountability and continued engagement with healthcare providers, the media and the public to ensure Kenyans receive accurate information on the implementation of Taifa Care.
