KMPDU rejects government plan to block insurance claims during working hours
The move follows remarks by Health CS Aden Duale, who said some doctors are running private clinics during office hours and directed the Digital Health Authority to enforce stricter oversight of insurance claims.
The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) has formally rejected the government’s proposed policy to block insurance claims pre-authorised by public sector doctors during official working hours, warning that the measure is unrealistic and could disrupt healthcare services, according to a statement from the union.
The move follows remarks by Health Cabinet Secretary Aden Duale, who said some doctors are running private clinics during office hours and directed the Digital Health Authority (DHA) to enforce stricter oversight of insurance claims.
In its statement, KMPDU’s National Executive Committee (NEC) said the proposed measure, which would allow insurance claims only during off-duty hours, does not reflect the realities of public hospitals. Doctors frequently work extended hours, handle emergency duties, and face blurred lines between on-duty and off-duty times.
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"The Cabinet Secretary for Health has publicly expressed intention to order SHA and DHA to reprogram the insurance systems to reject claims pre-authorised by doctors in the public sector during official duty hours, that is, from 8:00 am to 5:00 pm- allowing such pre-authorisations only during off-duty hours," a statement from the union said.
“The stated purpose of this measure is to reduce conflicts of interest, prevent diversion of public service time into private practice, and control rising insurance costs. However, Kenya’s public health system continues to face severe and chronic workforce shortages, with doctor-patient ratios far below internationally accepted standards. Extended working hours, emergency call duties, and blurred distinctions between on-duty and off-duty time make this policy unrealistic.”
Dual practice, the union noted, has emerged as a coping mechanism amid insufficient staffing, delayed remuneration, high workloads, and lack of incentives for exclusive public service.
The NEC described the use of fixed office hours (8:00 am to 5:00 pm) as a basis for automatic rejection of claims as operationally unrealistic, administratively arbitrary, and disconnected from workforce realities. The union warned that such a policy could lead to workforce attrition and disruption of service.
KMPDU emphasised that any policy affecting the terms, conditions, or scope of practice for public doctors must respect constitutional labour guarantees, align with existing Collective Bargaining Agreements, and be developed through meaningful consultation with recognised health sector unions.
The union urged the Ministry of Health, SHA, and DHA to pursue evidence-based alternatives, including structured and transparent dual-practice frameworks, roster-based or facility-verified authorisation mechanisms, incentives for exclusive public service, and accelerated recruitment and workload rationalisation within public facilities.
The NEC also committed to engaging the Ministry of Health and other authorities to present its position, demand suspension of unilateral implementation, and take industrial, legal, or advocacy action if the policy undermines service delivery or violates labour rights.
Speaking in Tharaka Nithi County during the commissioning of a new ultra-modern intensive care unit and an amenity wing at Chuka Level Five Hospital, Health Cabinet Secretary Aden Duale accused some government-employed doctors of diverting patients from public hospitals to their private clinics, a practice he said is bleeding the system dry.
“Kenyatta iko na 26 theatres, ukienda unaambiwa ukienda private nitafanya kesho, even the ones at KNH they either work at Kenyatta or those private hospitals," he said.
Duale has now directed the Digital Health Authority to clamp down on doctors who claim from private facilities during official working hours, despite being employed in public hospitals. From January, he says, the system will automatically block such payments.
“In January, the system will enforce something. Tell your members that SHA will only reimburse on any claim signed based on Practice 360 where you are employed… if you are employed kwa Level 5, hiyo hospitali na daktari will not be paid by SHA," he stated.
The health CS also took aim at private hospitals, accusing some of profiteering from desperate patients through exorbitant and unjustified charges.
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