MPs have summoned Health Cabinet Secretary Aden Duale to explain how two private firms were contracted under the digital health system that handles billions of shillings in Social Health Authority (SHA) medical claims yet they are not licensed as Medical Insurance Providers (MIPs) or Claims Settling Agents (CSA).
In an inquiry before the Health Committee of the National Assembly, Kitutu Chache South MP Anthony Kibagendi says the deal that brought Apeiro Limited and Livia Pharmaceutical Limited on board to manage the claims under the Safaricom-led consortium is against the Social Health Insurance Fund (SHIF) Act.
CS Duale has already confirmed that he has been summoned by the committee next week to respond to the issues that threaten the existence of SHA.
Mr Kibagendi notes that an analysis of SHA’s digital claims reports “demonstrates” fraud conduit concerns and hospital backlog crises that have exposed Kenyans to medical expenses beyond their reach.
“What I am raising and which the committee has the responsibility to report to Kenyans, is intended to seek clarity, accountability and transparency from the Cabinet Secretary for Health,” says Mr Kibagendi as CS Duale confirms his availability before the committee.
Kitutu Chache South Member of Parliament Anthony Kibagendi speaks during a Church service held on August 24, 2025, at Jesus Teaching Ministry (JTM) in Nairobi.
Photo credit: Billy Ogada| Nation Media Group
“I am appearing before the committee next week to answer the questions,” said CS Duale when reached for a comment.
The inquiries by Mr Kibagendi come as the report of Auditor-General Nancy Gathungu raises several breaches in the procurement of the SHA digital system, which includes uncompetitive procurement, lack of payment arrangement agreement, favourable contract clauses and lack of risk assessment.
“Internal controls are not being followed. The governance structure has problems and there is no risk management, hence we have all these issues happening,” added Ms Gathungu.
Asked previously whether the government should abandon the digital health system, Ms Gathungu’s response was candid: “The role and responsibility for action on the Auditor-General’s reports is with parliament.”
Auditor-General Nancy Gathungu.
Photo credit: Dennis Onsongo | Nation Media Group
The first-term MP also wants CS Duale to explain whether there was an open procurement process that led to the selection of Apeiro and Livia, and how much the Safaricom-led consortium received from the Sh104 billion contract.
The Kitutu Chache South MP specifically wants to know under what legal authority Apeiro and Livia were allowed to handle billions in claims when they are not licensed as MIPs as required by the SHIF Act.
Section 35 of the SHIF Act establishes under the SHA an office “to be known as the Claims Management Office, which shall review and process the claims made under this Act.”
The claims office shall, among others, be responsible for reviewing, processing and validating medical claims from healthcare providers and healthcare facilities, appraising medical claims based on the benefit package and issuing pre-authorisations for access to healthcare services based on the benefit package.
The law goes on to state that SHA may delegate this mandate to suitable entities, defined as a MIP or a Claims Settling Agent (CSA).
It further provides that a suitable number of such agents shall be contracted to manage claims across the zones identified in the regulations.
Mr Kibagendi wonders how SHA ended up with “only two handpicked entities- Apeiro and Livia” and whether it was the plan from the beginning.
“Does this mean that Apeiro and Livia could have been the entities that loaded bills from non-existent hospitals, leaving SHA technically bound to pay without authority to verify the claims? Would this not amount to outright fraud?” posed Mr Kibagendi.
CS Duale is also expected to respond to the contractual obligations of Savannah Informatics Limited and how much it is being paid to route claims it did not originally tender for.
Health Cabinet Secretary Aden Duale addresses the media at the Ministry of Health headquarters in Nairobi, on April 10, 2025.
Photo credit: File | Nation Media Group
The percentage of the Sh76 billion in unpaid hospital bills that are legally payable under the Essential Benefits Package (EBP) tariffs and what portion is 'locked out' by the SHIF Act is also a matter of inquiry before the committee.
“If Apeiro and Livia are being paid undisclosed fees, what is the total amount they have received so far and from which budget line and why are hospitals collapsing under debt while SHA continues to channel funds to third-party tech firms instead of providers?” poses Mr Kibagendi.
The Kitutu Chache South MP also seeks to know whether the Insurance Regulatory Authority (IRA) licensed Apeiro or Livia to handle claims, and if not, why there has been no regulatory sanction imposed on SHA.
He further wants to know whether SHA will publish all contracts, payments, and licenses for Savannah, Apeiro, and Livia
so that “Kenyans can judge whether SHA is a patient-centred health authority or, as critics allege, the most expensive fraud machine in Kenya’s history.”
