Health Cabinet Secretary Aden Duale has come out to defend the Social Health Authority (SHA) following an exposé involving a baby patient who sought treatment abroad, with the government health insurance failing to cover her medical expenses.
In the exposé aired on Wednesday, August 6, 2025, by NTV, the case of a family whose baby, Chloe Agnes, needed a life-saving heart surgery in India for Ksh1.625 million was highlighted.
According to the family, the baby’s father had been making contributions to the SHA and previously to the now-defunct National Hospital Insurance Fund (NHIF).
Upon visiting the Social Health Authority, he was reportedly promised that Ksh500,000 would be covered.
To raise the remaining amount, the family turned to friends, relatives, and Kenyans on social media.
The 10-month-old baby and her mother later flew to India for the surgery. However, SHA allegedly reneged on its commitment and declined to pay the promised Ksh500,000.
CS Duale also reportedly dismissed a key document presented to him as fake.
In a rebuttal issued on Thursday, August 7, Duale defended SHA, stating that its operations are fundamentally different from those of the disbanded NHIF, which he described as a “fraud-prone system.”
He emphasized that the new system’s processes for overseas treatment are guided by legal frameworks, including the Social Health Insurance (SHI) Act and Regulations, the Public Procurement Act, and circulars from the Office of the Attorney General (OAG) on foreign contracts.
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Duale explains why SHA cannot cover treatment for Kenyans abroad
According to the CS, SHA can only make payments to healthcare providers who are empaneled and have valid contracts with the authority.
He further explained that for a beneficiary to access treatment abroad, the treatment must be unavailable locally, and the patient must have fulfilled all contribution requirements under the SHI Act.
“The treatment must also be provided by an SHA-contracted facility. Overseas facilities must be accredited in their home country and recognized in Kenya. They must also be linked to an empaneled and contracted Kenyan health facility for follow-up care,” said Duale.
“The Benefits Package and Tariffs Advisory Panel (BPTAP) will annually generate a list of healthcare services that can be accessed outside of Kenya.”
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However, the CS noted that this specific list has not yet been gazetted.
Duale also pointed out that the preferred procurement method for overseas treatment is open tendering. He revealed that SHA plans to seek approval for a “Specially Permitted Procurement Procedure” from the National Treasury.
This process, he said, requires a written justification, inclusion in the annual procurement plan, and the preparation of tender documents to be submitted for approval.
“The Office of the Attorney General (OAG) must be involved from the beginning to the finalization of all contracts with overseas facilities. This includes negotiation, drafting, and vetting. Board approval is mandatory before any contract with an overseas facility is executed by the CEO,” Duale added.
In the NTV exposé, baby Chloe was supposed to undergo surgery at the Miot Hospital in Chennai, India, following a referral by Kenyan pediatric cardiologist Dr. Esther Kimani.
The cost of the surgery and air travel for mother and child amounted to Ksh1.8 million. Before they travelled, Dr. Kimani wrote to the Ministry of Health notifying them of the urgency of the matter in seeking to save baby Chloe’s life.
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