By the 254.ke Newsroom.
The Digital Health Agency (DHA) plans to change how hospitals file claims with the Social Health Authority (SHA), so that claims are generated directly from the patient-care records captured during treatment. DHA Chief Executive Eng. Antony Lenaiyara explained the change on Wednesday, October 28, 2026, during an engagement with the Parliamentary Health Committee chaired by Dr James Nyikal, according to reports. The agency says the approach should cut paperwork, speed up processing and make fraud easier to catch. No start date has been published.
What is DHA changing in the SHA claims process?
Under the plan, hospital staff would no longer re-enter the same patient details into a separate claims system. Information recorded while a patient is treated would flow into the claim, linking clinical records with claims management. Kenyans.co.ke and Kenya Today both carried the DHA’s account on October 28.
What the agency says will improve
| Area | DHA’s stated benefit |
|---|---|
| Speed | Fewer delays, because details no longer have to be matched across separate systems |
| Accuracy | Fewer inconsistencies from data entered twice |
| Workload | Less administrative work preparing claims |
| Validation | Stronger clinical and administrative checks before a claim is processed |
| Fraud control | Better traceability of the information behind each claim, and clearer audit trails |
These are the agency’s own expectations. The reports reviewed give no figures on expected savings or fraud reduction, no pilot facilities and no rollout timeline, and they do not describe the specific fraud-detection tools.
Why does this matter for hospitals and patients?
Claims have been a flashpoint since SHA replaced the National Hospital Insurance Fund. In September 2025, People Daily reported that SHA had halted more than Ksh3 billion in claims that lacked supporting documents and gave providers 14 days to resubmit. The same report said SHA had blocked more than Ksh10 billion in fraudulent claims since the Taifa Care rollout, a figure it attributed to the authority. Health CS Aden Duale had suspended 85 facilities earlier that month after a forensic audit.
The new approach also builds on a digital shift already under way. On September 1, 2026, SHA extended to September 30 the deadline for providers to use a DHA-certified health management information system (HMIS) to take part in the 2026/28 contracting cycle, Capital FM reported via allAfrica. Facilities that miss the requirements risk exclusion from SHA contracting. Claims for Level Four public hospitals had already moved to the Taifa Care HMIS by the end of June. For more on contracts, see our explainer on the SHA hospital contracts extension.
What patients should know
- Nothing changes at the point of care yet; the reports describe a planned change to how hospitals submit claims, not to what patients pay or receive.
- Keep records of your treatment and SHA contributions in case a facility asks to verify a visit.
- Be wary of anyone who contacts you about SHA registration by phone or link. See our guide to the fake SHA registration scam.
Frequently asked questions
When will SHA claims be generated from patient records?
No date has been announced. The reports from October 28 give no timeline, phases or pilot sites.
Who announced the change?
DHA CEO Eng. Antony Lenaiyara, during an engagement with the Parliamentary Health Committee chaired by Dr James Nyikal.
Will this stop SHA claims fraud?
The DHA says better traceability and validation should make fraud easier to detect. It has not published figures or described the tools, so the effect is untested.
Does it affect what patients pay?
The reports do not say so. They describe a change to how facilities file claims with SHA.
Information is as reported on October 28, 2026 and may be updated as the DHA and SHA publish more details.
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