Kenya’s healthcare system is changing. The Social Health Authority (SHA) will no longer pay claims from private facilities for services done by doctors on public duty during working hours. The move aims to stop absenteeism and conflicts of interest.
Health Cabinet Secretary Aden Duale said public doctors must work from 8 a.m. to 5 p.m. at their assigned facilities. The SHA will only reimburse claims if the doctor is registered and working at that facility. The new rules start in January. They form part of a wider effort to improve accountability and patient care.
Absenteeism and Patient Diversion
Some doctors have been diverting patients from public hospitals to private clinics, Duale said. They delay appointments in public hospitals but offer faster treatment privately. This practice is fraudulent and undermines trust in the health system.
Kenyatta National Hospital is one example. It has 26 fully equipped theatres and many specialists. Yet, patients face long waits. Some are told to wait months in public hospitals but can get treatment the next day in private clinics.
Private hospitals hire doctors who also work in public facilities. This dual practice creates conflicts of interest. Patients expecting public care are left waiting, while private clinics profit.
Policy Measures and Digital Enforcement
The SHA will introduce stricter monitoring. The Digital Health Authority system will track claims and verify where doctors are working. Claims from doctors practising elsewhere during work hours will be rejected.
Doctors are contracted to deliver full service to their assigned facilities. Salaries cover their public service hours. Any work outside these hours without approval is a breach of duty.
CS Duale said the policy will protect public resources and improve efficiency. The Digital Health Authority will monitor claims, detect irregularities, and enforce rules.
Challenges in Implementation
Implementing the policy will not be easy. Many doctors rely on private practice to supplement low wages. Public hospitals face staff shortages and heavy workloads. Long shifts make dual practice tempting, though controversial. The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) has raised concerns. They argue strict enforcement could hurt patient care. Emergencies and on-call duties make it hard to separate official and private work.
Despite these challenges, the government insists on accountability. Doctors must focus on public duties. Patient diversion to private clinics will not be tolerated. The goal is a more ethical and transparent healthcare system. The SHA’s move reflects a global challenge: balancing professional autonomy with public service obligations. Dual practice is common in countries where public salaries are low and private opportunities exist.
Digital tracking and strict reimbursement rules aim to strike a balance. The policy protects healthcare quality while ensuring doctors serve the public fully. It also reduces financial losses from fraudulent claims. For patients, the reforms could mean faster care, shorter queues, and more trust in public hospitals. Taxpayer resources will be protected, and services will become fairer.
Lessons for Health Systems
Kenya’s experience offers lessons worldwide. Digital verification can improve accountability. Public healthcare workers need proper incentives. Clear rules and enforcement prevent conflicts of interest.
Healthcare reforms must balance autonomy, patient needs, and institutional accountability. Clear policies strengthen trust and improve service. Engagement with stakeholders is essential to avoid staff demotivation or service disruptions.
Moving Forward
The SHA and Ministry of Health have taken a bold step. The new policy signals zero tolerance for absenteeism and patient diversion. Its success will depend on proper enforcement, cooperation from doctors, and reforms to address staffing and compensation.
Ethics, accountability, and transparency are key. Public hospitals must also provide reliable, timely care. Digital tools and clear policies can make this possible.
Kenya’s approach shows that governance, technology, and policy alignment are critical for strong health systems. The challenge is balancing enforcement with practical realities. When done well, both doctors and patients benefit from a fair, efficient, and ethical healthcare system
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