POLICY BRIEF
Issue
The Social Health Authority (SHA) has directed hospitals and doctors to attach theatre notes of surgeries to claim forms for reimbursement. While intended to verify claims, this directive breaches patient confidentiality, contravenes Kenya’s Data Protection Act (2019), and violates international medical ethics.
Concerns
• Excessive Disclosure: Theatre notes contain sensitive, detailed medical information far beyond what is needed for payment verification.
• Legal Breach: The Data Protection Act requires data minimization—collect only what is necessary.
• Ethical Violation: World Medical Association ethical codes demand strict confidentiality, disclosure only when necessary, and with safeguards.
• Patient Trust: Forcing disclosure undermines the doctor–patient relationship and public confidence in the healthcare system.
• Data Risks: Unnecessary sharing increases the chance of unauthorized access, misuse, or breaches.
Recommendations
1. Limit Claims Data to operative summaries, procedure codes ( e.g. ICD-10) and discharge summaries.
2. Retain Theatre Notes at hospital/doctor level, accessible only during audits, disputes, or with explicit patient consent.
3. Ensure Legal Compliance by conducting a Data Protection Impact Assessment (DPIA) before introducing new requirements.
4. Protect Confidentiality through anonymization, redaction, and secure electronic systems if additional data is ever required.
5. Engage Stakeholders (Kenya Medical Association Kenya Medical Practitioners and Dentists Council Office of the Data Protection Commissioner & Social Health Authority) to co-design ethical and effective claims protocols.
6. Use Post-Payment Audits rather than upfront mass disclosure to ensure accountability.
Conclusion
I fully supports SHA’s mandate to ensure accountability and prevent fraud. However, attaching theatre notes to claims is unlawful, unethical, and unnecessary. A balanced, collaborative approach can achieve both transparency and patient protection.
Immediate Call to Action:
Suspend the directive requiring theatre notes in claims, and establish a joint task force (Social Health Authority, Kennya Medical Association, Kenya Medical Practitioners and Dentists Council, Office of the Data Protection Commissioner) to develop compliant, ethical verification mechanisms.
Dr Simon Kigondu is the President of Kenya Medical Association