Kenya’s Ministry of Health has rolled out a real-time digital monitoring system that is fundamentally reshaping how public healthcare services are delivered, billed, and accounted for.
Deployed in January 2026 through the Digital Health Agency (DHA), the system links patient treatment directly to medicine issuance, shutting down long-standing loopholes that allowed fraud, manipulation, and diversion of patients to private pharmacies.
A key part of the reform is a decisive rule: public hospitals that fail to issue prescribed medicines available at their facilities will no longer be paid for them by the Social Health Authority (SHA). The move marks one of the strongest enforcement actions taken so far under the new Social Health Insurance framework.
Why the system was introduced
The digital overhaul was prompted by persistent failures within public healthcare facilities, where patients were routinely told that medicines were unavailable, only to be redirected to private pharmacies to purchase drugs that should have been provided free of charge. Health Cabinet Secretary Aden Duale said the DHA’s early data had already exposed alarming inconsistencies across counties.
“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,” Duale said.
In some counties, the gap was stark. In Kakamega, DHA data showed that while about 52,000 patients visited the referral hospital, only 9,000 were recorded as having received medicine. Similar disparities were observed in Bomet County, where more than 34,000 patients were treated, yet only 4,600 received drugs.
According to Duale, these patterns point to organised malpractice. “Either the drugs are stolen or there is collusion between hospital staff and the owners of those pharmacies,” he said.
How the system works
Under the new framework, every stage of a patient’s hospital visit — consultation, laboratory tests, diagnosis, and pharmacy — is digitally recorded in real time. The DHA platform is directly linked to SHA’s claims processing system, meaning reimbursement is no longer based on paper records or retrospective reporting.
“If you go through the system and you don’t get medicine, SHA will not pay for the medicine part of it,” Duale said. “From the system, we can tell that the patient was not given medicine. The provider of the medicine will not be paid by SHA.”
The system also includes biometric verification to prevent identity fraud, as well as a track-and-trace mechanism that follows pharmaceuticals from procurement to dispensing. Any facility that attempts to bill SHA for drugs not issued to a patient automatically triggers a claim rejection.
Duale said SHA would go further by subjecting claims to forensic checks. “We will only pay after we do due diligence. SHA will do due diligence, forensic audit and clinical review to make sure that the services you have offered are the right ones and that the Kenyan patient has actually received them,” he said. “We will not pay for fictitious claims that Kenyans have not received.”
What this means for patients
For patients, the reforms significantly shift power away from institutions and toward citizens. Through the Afya Yangu digital platform, patients can now access their full treatment history, prescriptions, and reimbursement balances.
“If you go to your Afya Yangu, you have all the information of the patient, including the balance of their reimbursements,” Duale said.
The Ministry is also enforcing the “Green Label Charter” at primary healthcare facilities (Levels 2 and 3), under which registered patients are entitled to walk in, receive consultation, tests, and medicine, and walk out without paying.
“Going forward, hospitals will display a ‘Green Label Charter,’ clearly outlining free services fully funded by the Government,” Duale said.
Facilities that fail to comply risk not only losing SHA payments but also facing regulatory and criminal sanctions, particularly where pharmacies dispense prescription-only drugs without a valid digital record.
A system designed to end manipulation
By linking care delivery directly to financing, the digital system closes the space that allowed cartels to thrive. Every missing drug now leaves a digital trail, and every unpaid claim sends a clear signal to facilities that non-compliance will carry immediate financial consequences.
The Ministry says the reforms are not only about cutting fraud but restoring trust in public healthcare. With real-time visibility, automatic enforcement, and patient-level transparency, the government argues that public health funds will finally flow to where they are meant to go — the patient.
