SHA's First Year Plagued by Systemic Failures

Kenyans battling severe health conditions, including cancer and kidney failure, along with vulnerable groups like teenage mothers and infants, face prolonged delays in accessing critical medical services due to widespread operational and policy failures within the Social Health Authority (SHA). A preliminary report presented by the National Assembly Departmental Health Committee on Tuesday, October 14, 2025, revealed at least 19 underlying issues, highlighting a challenging first year for the agency tasked with spearheading Universal Health Coverage (UHC) in Kenya.

The report, stemming from a fact-finding mission to ten health facilities, indicates that the SHA, which replaced the National Health Insurance Fund (NHIF) on October 1, 2024, is struggling with recurrent and systemic challenges that are overwhelming healthcare providers. Cancer patients are among the most severely affected, with essential diagnostic and follow-up tests often not covered, forcing them to incur substantial out-of-pocket expenses. This gap significantly increases the risk of treatment discontinuation and poor health outcomes.

Benefit Packages and Tariff Misalignments

A major point of contention is the misalignment of SHA's benefit packages and tariffs with the actual costs of medical care. For instance, the report cited a reimbursement of KSh 30,000 for a caesarean delivery and a 12-day limit for Intensive Care Unit (ICU) stays as impractical and insufficient. These limitations, coupled with restricted outpatient benefits at Level 5 facilities, discourage healthcare providers from offering specialised care and undermine the quality of service delivery.

Furthermore, critical service gaps were identified, including the absence of Neonatal Intensive Care Units (NICUs) in referral hospitals and shortages of oxygen, essential drugs, and utilities, often exacerbated by delayed reimbursements. Many hospitals are unable to pay staff salaries for months, leading to strikes and reduced morale among healthcare workers.

Exclusion of Vulnerable Populations and Digital System Challenges

The SHA has also been criticised for its failure to establish a clear national policy for identifying and enrolling indigent Kenyans, leaving thousands of disadvantaged individuals without access to essential healthcare. Teenage mothers, lacking national identification documents, face significant barriers to registration, denying them and their infants access to crucial maternal and child health services. Similarly, prisoners and individuals with chronic conditions experience inconsistent coverage across various facilities.

The digital system, intended to streamline operations, has been a source of widespread dissatisfaction. Approximately 81 percent of healthcare facilities are unhappy with SHA's digital platform due to frequent downtime, delayed reimbursements, and unreliable integration. A nationwide assessment by a consortium of healthcare providers, including the Kenya Healthcare Federation, the Kenya Association of Private Hospitals (KAPH), the Rural and Urban Private Hospitals Association (RUPHA), and the Christian Health Association of Kenya (CHAK), revealed that 92 percent of health facilities have experienced repeated portal outages.

Financial Strain and Unresolved Arrears

The financial strain on healthcare providers is severe, with many hospitals relying on credit to sustain operations. Over half of these facilities have warned that they cannot survive for more than three months without improved payments. This situation is compounded by huge arrears inherited from the defunct NHIF, which remain largely unresolved. For example, St. Mary's Mumias is owed KSh 19.2 million, threatening its operations and staff retention. Nyeri County, for instance, is owed KSh 230 million by SHA and KSh 289 million by NHIF.

The lack of transparency in SHA's payment system, where reimbursements are often issued as lump sums without clear disaggregation by fund type, further hinders effective tracking and accountability. The Ministry of Health, however, has attributed delayed operationalisation to funding shortfalls, noting that only 4 million out of 18 million registered contributors are actively financing the Social Health Insurance Fund (SHIF).

Leadership and Governance Concerns

The SHA was established under the Social Health Insurance Act, 2023, and began operations on October 1, 2024, replacing the NHIF. Its mandate is to provide accessible, affordable, sustainable, and quality health insurance for all Kenyan citizens. The Act also established three new funds: the Primary Healthcare Fund, the Social Health Insurance Fund (SHIF), and the Emergency, Chronic and Critical Illness Fund.

Despite recent appointments of senior directors and deputy directors in September and October 2025, aimed at strengthening leadership and operational efficiency, the Authority continues to face significant challenges. Public perception of SHA has been largely negative, with a GeoPoll survey in March 2025 indicating that 75% of respondents cited corruption and mismanagement as significant issues. Many Kenyans also feel that the NHIF offered better services, with a survey by the Consortium of Healthcare Providers revealing that seven in ten Kenyans believe SHA has performed worse in its first year.

Unanswered Questions and Next Steps

The parliamentary report highlights the urgent need for SHA to operationalise the Disputes and Resolution Tribunal, which is legally mandated but currently non-existent, leaving healthcare providers without structured mechanisms for redress. There is also a critical need for transparent means testing, as stipulated under Section 27 (2) (c) of the SHA Act, to ensure equitable access for all Kenyans and to achieve Universal Health Coverage goals.

The Senate Standing Committee on ICT has vowed to hold SHA accountable for delayed fund remittances to counties, which have disrupted essential healthcare services and delayed the procurement of drugs and medical supplies. The National Assembly's Health Committee is expected to table responses on the issues raised by MPs, with calls for improved communication and increased public awareness about SHA's benefits and registration processes.

What to Watch

The coming months will be crucial for the Social Health Authority as it navigates these systemic challenges. Stakeholders will be closely watching for concrete steps to address the identified failures, particularly regarding tariff adjustments, timely reimbursements, and the establishment of robust mechanisms for enrolling vulnerable populations. The ongoing parliamentary scrutiny and public demand for accountability will likely shape the future trajectory of Kenya's UHC ambitions.