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Health Cabinet Secretary Aden Duale has directed the Social Health Authority (SHA) to reject insurance reimbursement claims from doctors who treat patients in private clinics during official working hours in public hospitals.
Absenteeism among doctors in public facilities is a significant challenge in Kenya, with World Bank reports showing that up to 60% of doctors are absent during unannounced visits.
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Starting January, the SHA digital claims platform will flag and block claims from doctors registered in public hospitals if the records indicate they provided services in private facilities while logged as on duty in government hospitals. Duale announced the directive on December 16 in Tharaka Nithi County.
“It has become common for doctors in government facilities to redirect patients to their private practices, depriving the public hospitals that pay their salaries,” Duale said.
He added that this practice denies public hospitals both patients and revenue, while doctors continue earning government pay during office hours.
Duale cited Kenyatta National Hospital (KNH), which has 26 fully equipped theatres but often schedules surgeries months in advance. Brokers then contact patients offering next-day procedures in private facilities conducted by the same KNH doctors.
The Cabinet Secretary directed the Digital Health Authority to collaborate with SHA to enforce the new controls and warned that private hospitals submitting fraudulent claims will face sanctions. Tharaka Nithi Governor Muthomi Njuki, who chairs the Council of Governors’ Health Committee, supported the move, accusing some doctors of exploiting public hospitals to sustain private practice.
However, the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) criticized the policy, calling it unrealistic and potentially harmful to service delivery if applied unilaterally. The union argued that fixed clock-time enforcement (8 a.m.–5 p.m.) does not reflect the realities of public hospitals, where chronic staff shortages and extended working hours blur the lines between on-duty and off-duty periods.
“The public health system continues to face severe workforce shortages, forcing doctors to work long hours and take emergency duties, making rigid time-based rules unfair and impractical,” the union said.
KMPDU also faulted the government for failing to consult health workers before announcing the policy.
Absenteeism in Kenya’s public health sector has been widely documented. The 2018 World Bank Service Delivery Indicators report found that more than half of health workers were absent during unannounced inspections, with doctors showing the highest absenteeism at over 60%.
This issue undermines the delivery of skilled care and erodes public trust, as salaries are paid for services that often go undelivered.
Subsequent World Bank and WHO assessments have highlighted absenteeism as a major governance challenge, citing weak attendance monitoring, poor facility-level management, and limited enforcement of sanctions as key factors.
