Hospitals to get Sh116m for defunct Edu Afya claims

The Social Health Authority building in Upper Hill, Nairobi. [File, Standard]

Health facilities are set to receive a Sh116 million settlement covering life and last-expense claims under the defunct Edu Afya programme, a government-backed health cover for students in public secondary schools that was discontinued in December 2023.

The scrapped scheme accrued a total debt of Sh735.8 million in unpaid claims spanning inpatient, outpatient, and specialised care services.

Appearing before the Senate on Wednesday, Health Cabinet Secretary Aden Duale pledged to disburse the Sh116 million within two weeks.

"The life and last-expense claims will be settled by May 8. The house can hold me to that," Duale told senators.

He broke down the total outstanding liability: inpatient services account for Sh320 million, outpatient claims stand at Sh299 million, while life and last-expense cover totals Sh116 million. The remaining balance, he said, will be cleared within the next budget cycle beginning in July.

Duale attributed the delays to system checks and verification processes triggered by the transition from the National Health Insurance Fund (NHIF) to the Social Health Authority (SHA).

The issue was raised by Nairobi Senator Edwin Sifuna, who demanded answers over the State's continued failure to pay last-expense compensation to the family of Norbert Bulungu, whose daughter Pendo Vudavila died in 2023 while enrolled as a student under the scheme.

Under Edu Afya, families who lost children registered as students were entitled to a Sh500,000 payment, funds that some bereaved parents are yet to receive despite lodging formal complaints.

Students are now covered under a household plan through SHA, which provides access to health services both at school and at home. Edu Afya, by contrast, was a school scheme.

While defending the decision to phase out the policy, Duale maintained that SHA offered broader and more equitable coverage. 

He did, however, raise the alarm over rampant fraud, singling it out as the gravest threat to the new authority's sustainability.

"We have closed more than 1,200 facilities. The Director of Public Prosecutions has 24 files, including two implicating former CEOs of NHIF and SHA alongside several staff, while the Directorate of Criminal Investigations is probing 81 files," he said.

Mandera, Kisii, Migori, Homa Bay, and Wajir counties recorded the highest number of fraud cases, according to Duale.