Six months after its nationwide launch in October 2024, Kenya’s ambitious transition from the National Health Insurance Fund (NHIF) to the Social Health Authority (SHA) and its financing arm, the Social Health Insurance Fund (SHIF), is facing significant challenges, casting a shadow over the nation’s pursuit of Universal Health Coverage (UHC). An early assessment reveals a concerning decline in the implementation’s performance score, dropping from 46 percent in December to a meager 44 percent by February 2025, earning a “poor grade of D” . This regression, highlighted by the Rural and Urban Private Hospitals Association of Kenya (Rupha), points to a deterioration in crucial service delivery areas, notably the financial health of healthcare providers, the functionality of the new system, and the efficiency of outpatient reimbursements . While some progress has been noted in areas like e-contracting and patient verification, these minor advancements are struggling to offset the growing difficulties in critical domains such as claims management and ensuring the financial stability of hospitals and clinics across the country .

A major stumbling block in the initial phase of SHA/SHIF has been the glaring financial instability plaguing healthcare providers due to inconsistent and delayed payments . Alarmingly, nearly half of all healthcare facilities reported receiving irregular payments as of February 2025, with the situation particularly dire for smaller, level two and three hospitals, where a staggering 64 percent reported receiving no payments at all . This precarious financial situation is compounded by a substantial inherited debt of Sh30.9 billion from the NHIF, further straining the already limited resources of the SHA . The significant funding gap between the projected Ksh168 billion needed for full implementation and the mere Ksh6.1 billion allocated to the SHA in the current budget raises serious questions about the long-term sustainability of the scheme . Operational inefficiencies are also hindering progress, with increasing difficulties reported in claims management and the effectiveness of new reimbursement models . Moreover, ongoing system updates and persistent challenges in navigating the SHA portal are impacting service delivery, while public hospitals are grappling with long waiting times and service delays .

Public perception and adoption of the new healthcare system also present considerable hurdles. Despite the mandatory nature of the scheme, registration and active contribution rates remain worryingly low, with only 3.3 million Kenyans actively contributing out of the 19.4 million registered . This is further underscored by the fact that initial voluntary registration fell far short of the government’s target . Public resistance has been fueled by concerns over the new contribution model, which sees salaried workers contributing a higher percentage of their income compared to the previous flat rate under NHIF . This has led to calls for a fairer system, particularly for low-income households . Furthermore, reports indicate a concerning rise in out-of-pocket expenses for patients, particularly in private and faith-based facilities, contradicting the very aim of UHC to reduce the financial burden of healthcare . Coupled with reports of limited coverage and lower reimbursement rates for specialized treatments compared to the NHIF, the initial performance of SHA/SHIF suggests that significant challenges must be urgently addressed to ensure its effectiveness in providing equitable and quality healthcare for all Kenyans .

References:

Nation Explainer: How to make Kenya’s NHIF-SHIF transition less painful

Nation Healthcare reforms suffer setback as SHA performance declines

Nation Bold commitment to Kenya’s healthcare equity and growth