SHA has registered 33m people, but is it working?

Universal health coverage is a key pillar of the Kenya Kwanza administration’s health agenda, aimed at ensuring all Kenyans access quality healthcare regardless of their ability to pay. To advance this goal, the government overhauled health financing by replacing NHIF with SHA. Mercy Kahenda spoke to Health CS Aden Duale about the reforms’ achievements, shortcomings and plans to address implementation gaps.

1)Two years after the rollout of SHA, what would you describe as working?

UHC is moving from policy into actual care for millions of Kenyans. At the transition from NHIF, about 7 million people were registered. Over 33 million Kenyans are registered with SHA, and the network of contracted facilities has grown from 8,667 under NHIF to 10,713.

Through the Primary Healthcare Fund, we have financed 29.59 million visits by 10.17 million Kenyans, and more than 107,800 CHPs have reached over 9 million households and referred over 750,000 people for further care. Against the comparable NHIF baseline, supported deliveries have risen from about 985,500 to 1,305,427, surgical procedures from 227,741 to 545,844, cancer patients from 29,473 to 53,400 and kidney patients from 8,831 to 24,361. The oncology package now provides up to Sh800,000 per eligible beneficiary per year; the kidney transplant package has risen from Sh500,000 to Sh700,000; and the Emergency, Chronic and Critical Illness Fund has already supported 43,146 people with critical care.

The 922 Lifeline and the National Ambulance Dispatch Centre now coordinate emergency evacuation and stabilisation without any deposit or guarantee. Behind these services is real money: SHA has received Sh234.08 billion and paid Sh206.21 billion to facilities in all 47 counties.

KEMSA's order-fill rate has also risen from about 40 per cent to 91 per cent, so essential medicines are more reliably on the shelves, while digital systems now trace every patient, service and payment, which strengthens accountability and helps us detect fraudulent claims.

2) What are the biggest failures of SHA that the Ministry is willing to acknowledge, and how are they being addressed?

We acknowledge that the transition has fallen short in four areas, and we take responsibility. System downtime and authorisation delays disrupted care in the early months. Reliability now stands above 99 per cent, while the Health Management Information System will help map patients’ journeys and reduce repeated authorisations.

Payment delays placed financial pressure on facilities. We are strengthening claims processing, verification and reconciliation to ensure valid claims are paid promptly while protecting public funds.

Providers also lacked adequate guidance on tariffs, pre-authorisation, empanelment and contractual obligations. The HAKIKA contracting process and provider support teams are addressing these gaps.

Engagement with county governments, provider associations and patient groups was not always consistent. We are making it more structured to identify problems early and use feedback to improve implementation.

Ultimately, SHA must be judged by patients’ experiences, and we remain accountable wherever it falls short.

3) Registration is a positive step, and what do the numbers look like?

Today 33,252,795 Kenyans, or 69.9 per cent of the population, are registered. This includes 89.3 per cent of adults, 72.8 per cent of women and 66.2 per cent of men. The gap is children, at 47.2 per cent, largely because many households have not yet added their dependants. CHPs are helping families to do so during household visits.

4) Beyond registration figures and money collected, what evidence shows that Kenyans are receiving better healthcare?

The evidence is in the services being delivered. The 29.59 million primary healthcare visits, more than 1.3 million safe deliveries, the near doubling of cancer patients supported, the near tripling of patients on renal care and the more than doubling of surgical procedures. Cancer care now follows the National Cancer Control Programme's regimens and protocols, which have been digitised so that treatment and reimbursement are consistent across oncology facilities.

In emergencies, the 922 line received 32,442 calls and handled 1,252 incidents between 5 July and 11 October 2026, from road traffic injuries and cardiac cases to maternal emergencies, supported by 1,243 contracted accident and emergency providers.

I would, however, be candid in distinguishing two things. Our administrative data already shows a substantial expansion in financed care, but measuring long-term health outcomes, patient satisfaction and the reduction in out-of-pocket spending is continuing work. Digital records now allow us to track revisits, readmissions after surgery and medicine dispensing, and we are working with regulators, counties and providers to strengthen quality assurance and patient feedback.

5) How many registered members are actively contributing, and what is the Government doing to ensure low-income households are not locked out?

About a quarter of registered members are currently contributing, roughly 8.3 million people. That figure should be read against the fact that the 33.25 million registered include over 10 million children and dependants, while the obligation to contribute rests with the roughly 22.9 million adults and their households. Compliance in the informal sector is low, and improving it is a priority. Part of the challenge is affordability, and part is behaviour, since many people still seek cover only when they fall ill.

Our response begins with means testing, which assesses household income so that contributions, set at 2.75 per cent of household income, follow ability to pay rather than assuming every informal household earns the same. Lipa SHA Pole Pole allows households to pay their assessed contributions in instalments, and SokoHuru, an open-market premium financing approach, will allow banks and microfinance institutions to offer products suited to irregular incomes. For those who genuinely cannot pay, the Government is sponsoring 590,986 vulnerable households under its principal programme, and together with counties, NG-CDF, employers and other partners using the SHA Sponsorship Portal, sponsorship commitments stand at about Sh4.85 billion.

6) How much is required annually to deliver the SHA benefit package?

The first two years have shown that Kenya can mobilise substantial domestic resources for health. SHA has recorded Sh234.08 billion in receipts since October 2024, and the Government has allocated about Sh27.4billion to primary healthcare, averaging some Sh2.2 billion a month.

The precise annual cost of the package must come from actuarial costing based on disease burden, utilisation, the eligible population and expected prices, and the gap must then be measured against approved allocations and projected contributions.

What I can say is that we will close the gap through efficiency and a broader base, not by shifting costs to patients. That means widening contribution compliance and purchasing care strategically so that every shilling buys appropriate, cost-effective treatment. The Health Benefits and Tariffs Advisory Panel is reviewing the package, tariffs and access rules using actuarial analysis and health technology assessment. Government will continue to engage development partners on sustainable financing alongside domestic resource mobilisation.

7) How much does SHA owe health facilities, how long does it take to settle legitimate claims, and what is being done to prevent disruption?

SHA has received 14,027,463 claims worth Sh251.37 billion, of which 9,561,988 worth Sh177.75 billion have been paid. A further 2,252,182 claims worth Sh28.30 billion have been approved and are awaiting payment, and that is the amount properly described as owed. Another 1,060,833 claims worth Sh21.31 billion are still under review; these are not yet a debt, because not every submitted claim is payable. Some 881,367 claims worth Sh16.49 billion have been rejected and 271,091 worth Sh7.51 billion have been returned to facilities for correction, commonly because of incomplete documentation, incorrect coding or eligibility problems.

The law requires legitimate claims to be settled within 90 days, and our average turnaround now stands at 56 days. To improve further, we track every claim through ageing analysis on a first-in, first-out basis, and we have deployed 94 additional senior claims officers to the counties. Routine packages such as maternity and dialysis are now approved through AI-assisted adjudication, so that manual scrutiny is reserved for complex and high-value claims such as surgery, and Rapid Results Initiatives provide surge capacity as claim volumes grow.

HMIS captures care at the point of service; claims will increasingly be verified against the treatment actually delivered. For hospitals, that means less paperwork and faster payment, and for the public, it means earlier detection of fraud.

8) Patients report confusion over benefits, referrals and accredited facilities. Is outpatient care covered?

Outpatient care is covered, and primary outpatient care is in fact one of the most heavily used parts of SHA, averaging about 2.3 million visits a month.

Under the PHF, outpatient care is available at Level 2 and 3 facilities. and selected Level 4 facilities, with no limit on the number of visits and no copayment. It covers consultations, treatment of common illnesses, preventive care, selected laboratory tests and essential medicines, and a registered Kenyan does not need an active contribution to use it. There are 9,651 primary healthcare facilities, of which 6,153 are public, 452 faith-based and 3,046 private. SHIF adds outpatient laboratory tests for four priority conditions, namely diabetes, hypertension, sickle cell disease and asthma or COPD, together with inpatient and specialised care, subject to contribution and benefit rules.

Where a patient needs care beyond a primary facility, referral follows the Ministry's established referral framework, which we are automating with the Digital Health Agency. We accept that many Kenyans have not clearly understood the difference between primary and specialised outpatient care, and we are stepping up public education and provider sensitisation.

9) What independent assessment has the Ministry conducted, and what are the most common complaints?

The Ministry, SHA, CoG and DHA conduct quarterly joint support missions to the counties to assess how SHA and the Facility Improvement Financing framework are being implemented. The missions include patient exit surveys and meetings with SHA offices, county health teams and facility teams.

The most common complaints concern the contribution amounts assigned through means testing, members finding dependants on their records whom they do not recognise, and children added using the serial number on a birth certificate rather than the birth certificate number, which undermines verification. These are largely data and communication issues that inform our operational improvements.