SHA: The epitome of bedridden plan hyped as medical care revolution

What was meant to be a groundbreaking transformation of the healthcare system has instead unraveled into a muddled, frustrating transition.

The introduction of the Social Health Authority (SHA) that runs the Social Health Insurance Fund (SHIF) and other health funds was hyped as a means to universal healthcare.

But the move to hurriedly replace the National Health Insurance Fund (NHIF) has left hospitals and insurers and patients grappling with confusion and uncertainty as patients suffer more pain.

President William Ruto framed the reform as a fundamental shift towards fairness and inclusivity.

“Bottom-up economics means reforming NHIF and NSSF to level the playing field. It means ensuring a jua kali artisan can afford these contributions,” the Kenya Kwanza manifesto declared.

SHIF was launched as a key pillar of the Universal Health Coverage (UHC) initiative, replacing the scandal-ridden NHIF. The shift was intended to streamline healthcare financing, expand access, and eliminate inefficiencies that plagued NHIF.

“I want to assure the country that the challenges of fraud and corruption that bedeviled the NHIF will never be part of our universal healthcare plan as long as I am in charge,” Ruto said.

However, the transition has since morphed into a source of untold suffering and anxiety for patients and healthcare providers.

Under the new system, the government deducts 2.75 per cent of an individual’s gross salary, with a minimum contribution put at Sh300. Employers must remit payments by the 9th of every month. But the rollout has been anything but smooth, and backlash has been swift.

Six months since the October 1 launch, many Kenyans are unable to access healthcare. They have been suffering in silence — some dying unnoticed.

Baby Arianna Wairimu, a one-year-seven-month-old who is the poster child of a failed healthcare system, suffered from a rare disease known as Pearson Syndrome that affects various parts of the body, particularly the bone marrow and pancreas. She underwent a successful bone marrow transplant in India but later died from a rotavirus infection.

SHA was criticised for their handling of her medical expenses. Despite promises from officials, including Medical Services PS Harry Kimtai, SHA paid only Sh23,600 of the Sh1.6 million bill.

Some government employees have also been hit. The Rural and Urban Private Hospitals Association of Kenya has suspended cover for teachers and police due to unpaid billions.

“Patients seeking SHA or Medical Administrator Kenya Limited services at the point of service shall be informed that services are temporarily unavailable,” said Rupha’s notice.

Dr Brian Lishenga, Rupha chairperson, said the suspension would "continue indefinitely due to MAKL’s failure to engage with providers and address the serious concerns affecting service delivery”.

Hospitals lack clear directives, insurance providers are unsure how to process claims, and patients are left in limbo.

On the other hand, President Ruto has accused critics of resisting reforms to maintain corruption networks.

“They do not want a system that works because they want to continue stealing. The stealing is over. We are not going to give free money as was done under NHIF. We will only pay for services rendered,” he said last week.

But beyond the rhetoric, the UHC programme is buckling under the weight of poor execution, denying millions access to critical health services.

Doctors and clinical officers claim discrimination and bureaucratic hurdles are coming in the way of service delivery.

Patrick Chemosit, a clinical officer in Bungoma, claimed SHA was hijacked by cartels in the Health ministry.

"The Director General of Health knows very well that 80 per cent of healthcare services in this country are delivered by clinical officers, yet decisions made at Afya House seem to deliberately exclude us. The question we are asking Dr (Patrick) Amoth is, Why are the main drivers of healthcare being blocked from serving Kenyans?" he said.

On Tuesday, health workers held in demonstration in Nairobi and threatened to go on strike if their demands for better terms are not met. During the march, doctors condemned SHA’s failures, stating that even basic health services remain inaccessible to many medical professionals.

“SHA is only working for politicians. Healthcare workers cannot access it every 9th of the month. This is unacceptable,” said the Kenya Medical Practitioners Pharmacists and Dentist union Secretary-General, Davji Atellah.

SHA began operations on October 1, 2024, requiring employers to register their employees and dependents. By the same month, over 12.7 million Kenyans had enrolled — an impressive figure on paper. But the numbers mask the deeper crisis of implementation failures.

Of the 20.2 million registered beneficiaries, only 3.9 million actively contribute. Without broader participation, the system risks collapsing. Government officials insist SHA will stabilise once onboarding is complete, but skepticism remains high.

The authority, tasked with regulating healthcare financing, is supposed to ensure proper fund management, hospital reimbursements, and policy enforcement. Yet, delays and bureaucratic inertia have undermined these objectives.

Unlike NHIF, which functioned as a single national insurer, SHA runs SHIF, the Primary Healthcare Fund and the Emergency, Chronic and Critical Illness Fund. However, the shift in funding models has compounded the confusion.

While NHIF used a tiered contribution model, SHA imposes a flat-rate deduction, creating new financial burdens. Hospitals, used to NHIF’s reimbursement system, are unsure how to process SHA claims, leading to treatment delays and out-of-pocket expenses for patients.

The government set March 2024 as SHA/SHIF’s official start date, but with NHIF abruptly phased out, hospitals were left scrambling. Others are caught in limbo, and many Kenyans are paying the ultimate price. 

“We were promised a seamless transition, but hospitals have not received proper instructions,” said a Nairobi-based hospital administrator.

The Ministry of Health insists onboarding is ongoing, yet patients continue to face hurdles in accessing care.

For employees, the mandatory deductions have triggered widespread frustration.

“NHIF was bad, but at least we knew what we were dealing with,” said a Kisumu resident. “Now, we contribute more, but hospitals don’t even know if they are part of SHA.”

Legal experts warn that rushed implementation could open doors for financial mismanagement — the very problem that dogged the defunct NHIF. While SHA was designed to create accountability, gaps in regulatory enforcement could allow new avenues for corruption.

This week, SHA pulled down the payment list of Sh11.4 billion after the infiltration of the system by scammers. Acting Chief Executive Officer Robert Ingasira said criminals downloaded and doctored the list.

“Some people had downloaded the list, doctored it and were using it to con hospitals, telling them they are helping hospitals to be paid,” he said. 

The public had poked holes into inconsistency in relaying information about hospital payments, after the list was made public, only for it to be pulled down.

Ingasira said a number of hospitals complained that unknown individuals were calling them claiming to be reconciling National Hospital Insurance Fund debt.

“Hospitals reported to us that individuals who posed like SHA employees reached out to them, asking them to share their details so that they could help them process claims for NHIF debt,” he said.

The complaints were raised on Thursday and Friday last week, and the list was pulled down over the weekend. SHA cautioned healthcare providers and the public that the payment analysis document was fake and should be disregarded.

For now, the healthcare revolution that was promised remains a distant dream —another case of grand ambition crumbling under poor execution. If SHA fails, Kenya’s quest for universal healthcare may become yet another unfulfilled promise.