NAIROBI, Kenya, Jan 27 — The Social Health Authority (SHA) will begin rejecting reimbursement claims for medicines from county-run hospitals that fail to dispense prescribed drugs to patients, Health Cabinet Secretary Aden Duale has announced.
Duale said the move follows the detection of a widespread and persistent pattern in public health facilities where patients complete consultations, laboratory tests and scans, but leave without receiving medicines despite prescriptions being recorded in the system.
Speaking on the matter, the Health CS said data from the Digital Health Agency shows alarming disparities between the number of patients treated and those who actually receive medication.
“If you go to your Afya Yangu, you have all the information of the patient, including the balance of their reimbursements,” Duale said.
“The Digital Health Agency has detected a pattern where patients go through the hospital, see the doctor, go to the lab, everything is done, but they do not get drugs.”
Worrying trend
He cited Kakamega County Referral Hospital, where records showed that out of about 52,000 patients treated, only 9,000 were issued with medicines.
A similar trend was observed in Bomet County, where approximately 34,000 patients visited public hospitals, but only 4,600 received drugs.
Duale said the trend has fueled the mushrooming of private chemists and pharmacies around public hospitals, raising serious concerns about possible theft of medicines or collusion between hospital staff and private pharmacy owners.
“So either the drugs are being stolen, or there is collusion between hospital staff and the owners of these pharmacies, where patients are told to go and buy the drugs outside because they are supposedly not available in the hospital,” he said.
To curb the malpractice, Duale said the SHA has activated system-based checks that will link treatment records directly to reimbursement claims.
Facilities that bill for medicines that were not issued to patients will not be reimbursed for the pharmaceutical component of the claim.
“Beginning this week, if a patient under primary healthcare and the Social Health Insurance Fund goes through the system and does not receive medicine, SHA will not pay for the medicine part of the claim,” he said.
“Our system can tell that a patient saw a doctor, went to the lab, even did a CT scan, but did not get medicine.”
He warned that going forward, any facility submitting claims that include drugs not dispensed will have that portion of the claim rejected.
“The provider of the medicine will not be paid by SHA,” Duale said, adding that the move is aimed at protecting patients and safeguarding public health funds from abuse.
