Doctors reject CS Duale’s proposed restrictions on insurance pre-authorisation

The Kenya Medical Practitioners, Pharmacists and Dentists' Union (KMPDU) has strongly opposed a government proposal to limit insurance claim pre-authorisations by public sector doctors to off-duty hours, calling the measure operationally unrealistic and disconnected from clinical realities.

In a statement released on Wednesday, the union detailed its objections to Health Cabinet Secretary Aden Duale’s expressed intention to instruct the Social Health Authority (SHA) and Digital Health Agency (DHA) to reprogram insurance systems.

The proposed change would reject claims pre-authorized by public sector doctors during official duty hours from 8a.m. to 5p.m., allowing such actions only outside those times.

"The stated purpose of the proposed measure is to reduce conflict of interest, prevent diversion of public service time into private practice, and control rising insurance costs," read the statement signed by KMPDU officials Dr. Davji Atellah (Secretary General), Dr. Abidan Mwachi (Chairman), and Dr. Mercy Nabwire (Treasurer).

The union highlighted ongoing challenges in Kenya's public health system, including severe workforce shortages where doctor-patient ratios fall below international standards, leading to extended working hours and blurred lines between on-duty and off-duty periods.

It described dual practice as a coping strategy amid insufficient staffing, remuneration delays, high workloads, and lack of incentives for exclusive public service.

“Time-based administrative controls do not effectively reflect the operational realities of public hospitals and risk arbitrary, disproportionate, and inequitable enforcement,” said the union.

“The proposed mechanism has not undergone formal consultation with organized labour and/or other major stakeholders in the health sector.”

While acknowledging the legitimacy of concerns over accountability and resource management, the union rejected the fixed clock-time approach as operationally unrealistic, administratively arbitrary, disconnected from clinical and workforce realities, adding that it would probably result in perverse consequences such as workforce attrition and disruption of service.

KMPDU affirmed that any policy affecting public sector doctors' practice must respect constitutional guarantees of fair labor practices, align with existing Collective Bargaining Agreements (CBAs), and involve meaningful consultation with recognized unions.

Instead, KMPDU called for evidence-based alternatives, including: structured and transparent dual-practice frameworks; roster-based or facility-verified authorization mechanisms instead of inflexible time stamps; incentivised exclusivity, where exclusive public service is required; as well as accelerated recruitment, retention, and workload rationalization within public facilities.

The doctors’ body hence mandated its National Executive Committee (NEC) to seek urgent engagement with the Ministry of Health, SHA, and DHA;.

This so as to demand suspension of unilateral implementation pending consultations, and pursue industrial, legal, or advocacy actions if the policy violates labor rights or disrupts services.

"The NEC reiterates that the union remains committed to strengthening public healthcare delivery and protecting patient welfare, and that sustainable reform must address systemic constraints rather than individualize structural failures," added the statement.