There is no gain saying. SHA has its’ good share of trouble but targeting the Health CS Aden Duale or Chairman Dr Abdi Mohamed for ouster misses the point. Why? There are no better angels. SHA suffers from systemic and historical cartel-capture as inherited from defunct National Health Insurance Fund (NHIF).
When history examines Kenya’s transition from NHIF to the Social Health Authority (SHA), much of the political heat and public scrutiny will fall on Health Cabinet Secretary Aden Duale.
In recent weeks, his name has been invoked as if he alone midwifed the new health financing system that has faced teething challenges, legal challenges, and fierce public skepticism.
Yet, to single him out as the sole culprit — while populist— is to misrepresent the law, ignore the collective nature of government, and obscure the larger context that shaped SHA’s emergence.
Collective Decisions
SHA was not a unilateral directive of Aden Duale. Like every major policy reform, the establishment of the Authority was debated, adopted, and passed as a collective Cabinet decision before being presented to Parliament.
The Constitution and the Executive arm of government are explicit: Cabinet decisions bind all members collectively.
This means responsibility is shared across ministries, including Treasury, Health, and the Attorney General’s office. It is therefore misleading to reduce the debate into a personal indictment of one Cabinet Secretary.
Anchored in Law
The Social Health Insurance Act, 2023, which birthed SHA, is not a regulation smuggled in by a single docket. It was processed through Parliament, debated in committee, and signed into law by the President.
Its legitimacy stems from statute—not from an executive fiat. Duale’s role, much like that of any other Cabinet Secretary, is to implement what Parliament enacted and what Cabinet approved. In law, he is bound as much as empowered.
We are surprised that some MPs are now playing to the public gallery yet they have power to amend the law accordingly.
Burden of Continuity
It is often forgotten that Duale inherited SHA as a policy blueprint. The Health Financing Reforms Taskforce, the policy papers that informed SHA, and the legislative drafts that culminated in its establishment were developed long before he assumed a direct role in shepherding the transition.
As in many ministries, policy continuity binds each incoming officeholder to carry forward decisions already in motion.
To claim that SHA is Duale’s sole creation ignores the bureaucracy and multi-year processes that preceded him.
Oversight Beyond Health
SHA is not confined to the Ministry of Health alone. Its financing framework draws deeply from the Treasury. Its legal design was cleared by the Attorney-General.
Its oversight mechanisms run through Parliament, especially committees such as Health, Finance, and Budget. If SHA contracts raise questions, or if implementation stumbles, then the accountability net must stretch far wider than one minister.
In fact, the Auditor-General, Controller of Budget, and Senate will play crucial roles in its long-term viability.
Political Lightning Rod
Aden Duale is no stranger to controversy. His outspoken style, sharp tongue, and unapologetic defense of government policy often make him a lightning rod for political anger.
Yet this very trait obscures the structural issues at play. Criticism of SHA may well be justified on grounds of rushed implementation, lack of transparency, or weak consultation—but turning it into a personal vendetta against Duale does little to solve those problems.
Instead, it personalizes systemic flaws, letting the collective machinery that birthed SHA escape deeper scrutiny.
Need for Balance
Kenya deserves honest conversations about SHA—its design, its financing, its inclusivity, and its long-term sustainability.
But accountability must be apportioned where it belongs: across the Cabinet that approved it, the Parliament that enacted it, and the oversight institutions that monitor it.
Aden Duale may be the face of the reforms, but he is not their sole architect. To insist otherwise risks distorting public discourse, distracting from genuine policy critique, and unfairly vilifying one man for a collective decision.
SHA will succeed or fail not on the shoulders of Duale alone, but on the strength of Kenya’s collective governance.
Criticism alone or change of office bearers won’t be a panacea to SHA challenges – which have narrowed to payments to various facilities
