Health crisis brews as SHA halts monthly payments for millions

Social Health Authority CEO Dr Mercy Mwangangi, on June 3, 2025. [Edward Kiplimo, Standard]

There is growing uproar among non-salaried Kenyans who say they are unable to remit their annual premiums to the Social Health Authority (SHA), even as the Ministry of Health pushes for mandatory registration to the scheme.

Initially, under the revised payment model, non-salaried individuals were allowed to make monthly contributions, a relief to many who could not afford annual payments.

However, that option has recently been withdrawn, sparking frustration.

This change comes despite President William Ruto’s assurance that premium financing would allow Kenyans to “SHA lipa pole pole”, where individuals make pay in instalments.

According to the Social Health Insurance (General) Regulations 2024, individuals in informal employment were originally required to pay their premiums annually to avoid service disruptions, unlike the now-defunct NHIF, which permitted monthly payments.

To ease the burden and reduce the risk of payment defaults among informal sector workers, who make up about 80 per cent of the population, the government had temporarily allowed monthly contributions equivalent to 2.75 per cent of one’s income.

However, starting this month, many non-salaried individuals say they are no longer able to remit monthly payments, raising concerns about affordability and accessibility.

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According to the law, non-salaried Kenyans are expected to contribute 2.75 per cent of their income annually.

Meanwhile, salaried workers have the same rate automatically deducted and remitted by their employers each month.

"I have been trying to pay SHIF for this month unsuccessfully. The payment portal dictates I pay annually,” questioned Kariuki Chege.

He added, “I have been paying monthly premiums, but now I might be forced to default contribution because I cannot raise the Sh15,000 annual premiums.”

Chege questioned what happens to the contributions he has made to the Fund since January.

“I do not think I shall pay any more to SHIF. The monthly contribution was affordable. What happens to contributions already in?”

“Many of us may not know how messy this SHA annual contribution thing is until we desperately need it. I felt the pain of a family last night,” Collins Bett said on X space.

“The desperation was heartbreaking”.

Bett further pleaded with Health Cabinet Secretary (CS) Adan Duale to act. “Just do something about that policy, save Kenyans”.

Confusion over premium payments continues, despite President Ruto reaffirming his administration’s commitment to Universal Health Coverage (UHC) and flexible financing options.

“Lipa SHA pole pole has been made possible through a strategic partnership between the Ministry of Health, cooperatives, mobile network operators, and financial institutions via the Hustler Fund,” said the president.

“This system allows Kenyans to remit SHA contributions through flexible instalments — whether monthly, weekly, or even daily, based on their ability.”

However, insiders at SHA acknowledge the system is not working smoothly. A source involved in SHA sensitisation, who requested anonymity, said the Lipa pole pole portal was inoperative last week and over the weekend.

“Yes, the financing option is there. But unfortunately, the portal has not been operational. This issue has been escalated because many individuals are complaining,” said the source.

Contacted by The Standard for a comment, SHA Chief Executive Officer (CEO) Dr Mercy Mwangangi said the matter will be addressed.

Mwangangi said the health CS will release a statement on the matter today, noting that the SHA laws provide for an annual payment for individuals in the informal sector.

“The SHA Act provides provisions for annual payments for the informal sector,” the CEO told The Standard.

Mwangangi emphasised that a key important principle of health insurance is the pooling of risks by ensuring cross-subsidisation of risk.

According to the CEO, cross-subsidisation of risk involves pooling resources across different groups, for example, young and old, poor and rich, healthy and sick, to ensure equitable access to healthcare.

“A key constraint in managing insurance schemes is adverse selection. In adverse selection, an insurance pool is depleted by a lack of predictable, regular, and consistent premiums into the pool vis-à-vis claims made,” added Dr Mwangangi.

She added, “Our analysis demonstrates that it is necessary to ensure sustainability. The law provides for this. The Government has provided a framework”.

Despite the uproar of individuals in the informal sector, she said SHA lipa pole pole is meant to help individuals meet their annual premiums.

“SHA Lipa pole pole is now available to facilitate the annual premiums from the informal sector. This is a flexible payment framework, not a loan. And no interest is charged,” she explained.

However, an insider at SHA who has been sensitising locals to register for the scheme admitted the lipa pole pole portal was not working last week and over the weekend.

“Loans at there, but unfortunately, the portal is not operational. This shall be escalated to have a solution because many individuals are asking,” said the source, who requested to remain anonymous because she is not allowed to speak to the media.

It is, however, beating logic to take a loan to pay for a health scheme, as loans from the hustler fund are limited, with some individuals only allowed Sh500, far below what is needed for annual premiums.

Some people have loan limits of Sh500 from Hustlers fund, yet are required to pay about Sh10, 400 an amount they cannot raise.

Individuals are also living from hand to mouth, with hard economic times with no employment.

The challenge of remitting pay to the fund is reported even as the Health CS maintains that SHA is working, raising questions on which segment of people are benefiting, when Kenyans are not able to remit their annual premiums.

Speaking in Garissa over the weekend, Duale maintained that SHA is working, with patients able to get quality care in both private and public hospitals.

At least 23.6 million Kenyans have registered for the scheme, with Kiambu and Nyeri taking the lead.

“SHA is working. 23.6 million Kenyans have registered for SHA. And we are telling people of Kenya, we have all the evidence to show Universal Health Coverage (UHC) is working,” said Duale.

“We want to cover 100 per cent of the Kenyan population. NHIF was only covering salaried people, who were only 20 per cent of the population. We want to bring equity.”

Further, the CS dismissed feedback by locals who had a challenge in assessing care, as he maintained that systems were working.

“If you register with SHA and are admitted to the ICU, the scheme will pay Sh28,000. For cancer treatment, registered members can receive up to Sh550,000 per year,” said the CS.

Duale then directed local administrators to assist residents across the country in registering for SHA.

Despite his push for increased registration, actual remittance of contributions remains low among those in the informal sector.

Currently, only 437,000 households in the informal sector are up-to-date with their monthly contributions, as required by law.

This marks a significant drop from the 700,000 who were contributing under the now-defunct NHIF.

Of the registered individuals, 13.6 million are in the informal sector, 3.4 million are in the formal sector, and 5.7 million are dependents covered under both categories.

However, only 3.8 million are actively making their contributions, 3.4 million in the formal sector and just 0.4 million in the informal sector.

“Before the transition, NHIF had 4.7 million active contributors in the formal sector and 700,000 in the informal sector,” a senior SHA employee who transitioned from NHIF told The Standard.