The Kenyan Senate has commenced an in-depth investigation into alleged collusion involving the Social Health Authority (SHA) and private insurance companies over a Ksh. 6.3 billion medical insurance contract with the National Police Service (NPS). This probe responds to increasing reports of delayed or denied compensation for police officers injured in the line of duty a core part of the contract between the NPS and the recently rebranded SHA, formerly known as the National Health Insurance Fund (NHIF).
Eliud Kinuthia, Chairperson of the National Police Service Commission (NPSC), testified before the Senate Security, Defence, and Foreign Relations Committee, highlighting a troubling pattern: only a minority of injured officers have been compensated, while most claims are rejected or delayed without clear explanation. According to Kinuthia, SHA has been dismissive of the officers’ complaints, leading to frustration among NPSC leadership and vulnerable police officers who lack union representation to voice their grievances.
As of the latest report, a total of 1,966 police officers have filed claims for compensation under this medical contract. Out of these, only 937 claims valued at Ksh. 709 million have been settled, while 240 claims worth Ksh. 240 million were outrightly rejected by insurers. Another 161 claims, totaling Ksh. 108 million, remain in processing, while 422 claims, valued at Ksh. 444 million, are undergoing SHA’s internal review. Adding to the backlog, 106 claims are held up due to insufficient documentation.
“They are targeting a very vulnerable group that lacks unions,” Kinuthia told the committee. “NHIF can be arrogant toward us, and we have nowhere to turn. We’ve been disadvantaged because we have no union to represent us, and we can’t raise our voices, so we suffer in silence.” This frustration reflects a deeper issue rooted in the agreements and the perceived treatment of police officers, who often put their lives on the line to protect the public but struggle to access adequate care and compensation when injured.
The confusion began when the NPS initially signed a contract with the NHIF, designating it to compensate officers injured on duty. However, recognizing that the NHIF lacked the capacity to handle these claims, the NPS subsequently agreed to work with private insurers as underwriters. According to the NPSC, these private insurers have since created roadblocks in the claims process, making it increasingly difficult for injured officers to access their entitled benefits.
Augustine Wafula, the SHA claims manager, explained to the committee that the ongoing issues stem from discrepancies between the NPS-NHIF contract and a separate agreement that NHIF had with the private insurers. As an example, he cited a recent claim denial, where an officer’s assault in his own home was ruled ineligible for coverage on the grounds that it was not related to active duty.
This explanation did not sit well with the NPSC. Kinuthia asserted that the private insurers were not directly recognized by the NPS and that SHA must bear responsibility for selecting and managing these co-insurers. Kinuthia emphasized that police officers, due to the nature of their work, are effectively on duty around the clock. “They are telling us that the officer was attacked while sleeping at home, and so they argue that he was not working at the time. I want to categorically state that a police officer does not sleep. We simply rest because we are on duty 24 hours a day,” he said.
The Senate committee, chaired by Senator William Cheptumo, has pledged to pursue a thorough investigation and hold SHA accountable for the contract’s failures. Cheptumo criticized SHA’s management, pointing out that the organization should have foreseen and prevented such issues.
“The real enemy here is SHA, or NHIF,” Cheptumo stated. “They may hide behind the fact that they are not answerable to the Insurance Regulatory Authority, but I assure you, they will be answerable to us. We will call all the co-insurer companies here to demand answers as to why they are not paying the claims.”
The Senate’s involvement aims to expedite compensation for affected officers and examine SHA’s management of the police insurance contract to prevent similar issues in the future.
