Senators pressure SHA to explain criteria to reject Sh16b claims

SHA CEO Mercy Mwangangi before the  Senate Committee on Health at Bunge Towers, Nairobi. May 14, 2026. [Elvis Ogina, Standard]

The Social Health Authority (SHA) has rejected Sh16 billion worth of claims since its inception in October 2024.

Chief Executive Officer Mercy Mwangangi told the Senate Health Committee that Nairobi County leads with Sh3.8 billion worth of the rejected claims, with the legislators wondering what has been done to address the matter. Dr Mwangangi said Sh139.5 billion payments have been made to health facilities as of April 30. Nairobi received the highest amount at Sh26.2 billion. Claims under review amount to Sh31.5 billion.

But committee members sought to know the criteria used to reject the claims, arguing that some had been withheld over lame excuses such as a lack of birth certificates.

Mwangangi said all the rejected claims were referred back to the health facilities with reasons and actions needed to be taken.

The team sought to know whether SHA was working with the Council of Governors. “I would like the SHA CEO to tell us whether they have, for example, engaged Nairobi and Mandera County governments over the Sh3.6 billion and Sh1.3 billion rejected claims respectively since this may affect health service delivery if not addressed,” said the committee chair, Jackson Mandago. 

Mwangangi said settlement of county claims stands at 67 per cent, and that a technical working group has been formed with the Governors.  But members insisted that the medical cover was not working, asking the authority to address the complaints to gain Kenyans' confidence.

Ledama ole Kina raised concerns about enhanced cover for a few individuals, saying the defunct National Hospital Insurance Fund was clear on such covers. He said SHA was meant to create uniformity for all patients. 

“You have heard Kenyans raise concerns that SHA is not working. We should have a medical scheme that serves the ordinary Kenyan by ensuring they can access quality medical care at facilities that are near them. The SHA board should have its house in order,” said the Narok representative.

To address inefficiencies, Mwangangi told Senators that SHA was rolling out biometrics, which include facial identification and fingerprints, so that patients do not have to leave their beds to be served. She said they would set up mobile units so that people do not have to go to the SHA offices.  Mwangangi said the authority had set aside Sh900 million per year as a grant for teenage mothers. 

Mwangangi said SHA inherited debt of Sh33 billion from NHIF and they were verifying which claims were genuine. So far, Sh4 billion worth of payment claims have been made, with claims below Sh10 million being given priority.

Members also raised concerns about drug shortages, wondering how the agency was working with the Kenya Medical Supplies Authority.

Senators also sought to know the status of NHIF staff and whether they have been absorbed into SHA, with Mwangangi saying they had requested the Public Service Commission to redeploy them.

They also sought to know what measures had been put in place to ensure that 30 million people registered with SHA make their contributions, noting that only 6 million were submitting their payments.