Healthcare stakeholders question Ruto's SHA sponsorship approach

President William Ruto’s launch of health coverage for the poor and other vulnerable groups under the Social Health Authority (SHA) has sparked criticism, with experts describing it as unlawful.

The Social Health Act 2023 and its accompanying regulations require the National Treasury and county governments to allocate funds to support vulnerable households.

However, critics have pointed out that no budget has been set aside, nor have beneficiaries been identified, raising questions about how enrolment into the scheme—aimed at providing quality care to all—will be managed.

Over the weekend, President Ruto announced that the government had committed Sh4.4 billion to SHA to cover 2.2 million indigents, representing approximately 558,000 households.

The Rural Private Hospitals Association of Kenya (RUPHA) welcomed the move, calling it long overdue, as the identification of indigents is a key provision under the SHA Act.

At the same time, the association criticised the way the programme was launched, acknowledging some positive aspects but highlighting several concerns.

RUPHA chairperson Brian Lishenga noted that the SHA Act stipulates that funds for indigents and vulnerable groups within the Social Health Insurance Fund (SHIF) must be appropriated by the National Assembly and county governments.

Means testing

To date, such allocations have not been made.

According to the Act, indigents are those who are poor and unable to meet basic needs, while vulnerable individuals include those at risk of abuse and neglect—such as orphans, people living with disabilities, widows and widowers.

“Kenya is estimated to have at least five million indigents. The cover launched today targets 2.2 million households, which is still far below what is envisaged,” Dr Lishenga said.

The law requires SHA to use means testing to determine indigents, vulnerable persons, the elderly and those with disabilities, a process that is yet to begin.

“The National Treasury has not yet carried this out, and there is no evidence that the National Assembly has appropriated funds for what was launched today. Most counties have neither identified indigents nor allocated funds to be remitted to SHA,” he added.

President Ruto did not address budgetary allocations during the launch but praised Kenyans of goodwill who are willing to support indigents and vulnerable persons.

“There are many people of goodwill. We have a friend of Kenya who has contributed and promised to pay for 113,000 Kenyans. MPs have also stepped up, and I urge MPs to use Constituency Development Funds (CDF) to support those unable to pay from their constituencies,” the President said.

He thanked several politicians—including MPs, governors and donors—for supporting the sponsorship programme for indigents and vulnerable persons, revealing that MPs have covered the SHA costs for 508,000 people.

“These leaders have taken on the responsibility of paying for other Kenyans. We shall carry this burden together and will not relent until every citizen unable to pay has been covered, making healthcare truly universal,” Ruto said.

Surprisingly, during the launch, SHA opened a page on its website referring to support for the vulnerable as “sponsorship”.

The portal indicated that President Ruto had contributed Sh4.4 million, while an anonymous sponsor made the largest single donation of Sh900 million.

Refugee Point, Mombasa Cement, and UNHCR are supporting 150, 2,500, and 22,155 beneficiaries respectively.

At the county level, Cheptiret Kipchamo Ward in Uasin Gishu supports 291 people, while Baringo, Mombasa, and Lamu counties each have 20,000 beneficiaries enrolled.

Several politicians have made significant contributions, including Japheth Miriti, MP for Maraa Constituency, who paid Sh5.5 million, Samburu West MP Naisula Lesuuda, Sh1.9 million, Janet Jepkemboi (Turbo), Sh2.4 million, Phelix Odiwuor (Langata), Sh2.3 million and Nakuru Town East MP David Gikaria, Sh3.6 million.

Other notable contributions include Sh2.8 million from Mwangi Kiunjuri (Laikipia East), Sh23 million from Trans Nzoia Governor George Natembeya, and Sh1.9 million from Bahati MP Irene Njoki.

Sustainable cover

Additional donations include Sh5.6 million from Migori Governor Ochilo Ayacko, Sh117 million from Murang’a Governor Irungu Kang’ata, Sh3.4 million from Kikuyu MP Kimani Ichung’wah, and Sh3.6 million from Mombasa Governor Abdulswamad Shariff.

Dr Lishenga emphasised that the only way to guarantee quality access to care for vulnerable and indigent persons is to register them for medical cover appropriated through the National Assembly and counties, as required by the Act.

“SHA regulations mandate that the National Treasury deducts and remits funds, while county finance chiefs do the same. This is the only way to ensure continuous medical cover year after year.

“While we welcome the initiative, Parliament has not fulfilled its role. We expect the National Assembly to allocate funds as stipulated, while SHA and counties should identify needy households across Kenya,” he said.

President Ruto acknowledged the Social Health Insurance Act 2023 and the SHA Regulations 2024, which mandate national and county governments to identify and sponsor disadvantaged households.

“We are fully within the law. The Ministry of Health, in collaboration with the Ministry of Labour, has already created a list of households. This list is available to our leaders, philanthropists, donors and development partners who want to support deserving families,” he said.

However, Dr Lishenga criticised the launch as an “act of goodwill” calling for sponsorship, contrary to legal requirements.

He pointed out that through SHA, Kenyans can access treatment at any hospital—including private facilities—without paying.

According to the President, at least 9,000 hospitals have been accredited by SHA.