When Kenya launched the Social Health Authority (SHA) as the cornerstone of universal health coverage, the promise was clear: to ensure every citizen could access essential health services without facing financial ruin. Yet today, that promise faces a serious credibility test. Recent developments indicate that many Kenyans, particularly the unemployed and low-income earners, are being turned away from public hospitals unless they first settle their full-year SHA premium in advance. This development contradicts the October 2024 assurance that eliminated upfront payments, and it has created uncertainty and distress for millions who had hoped the new system would ease their access to care. While the government’s “Lipa SHA Pole Pole” initiative was introduced as a flexible payment model, its application has exposed a difficult paradox—patients unable to pay full premiums are being directed to loan facilities such as the Hustler Fund, raising concerns about equity and affordability in health access.

The data reinforces the gravity of this policy gap. As of May 2025, around 22 million Kenyans were registered under SHA. However, only 4 to 5 million were actively contributing. This stark difference highlights a growing segment of the population—nearly 17 million—who are nominally enrolled but effectively excluded from coverage. Field reports indicate cases where patients who had made partial payments through monthly KSh 1,030 contributions were still denied treatment unless they completed the full annual sum of KSh 12,460. This shift from previous messaging has created confusion within the public and among healthcare providers alike. Hospitals are left navigating between policy directives and practical enforcement realities, while patients face an impossible choice between debt and delayed care. The concern here is not just administrative inconsistency but a fundamental disconnect between the objectives of health reform and its practical execution.

Efforts to finance the health sector sustainably must not eclipse the foundational goal of protecting all citizens—especially the most vulnerable. Leveraging loan facilities to pay for health premiums, even under a well-meaning “pay slowly” framework, may alleviate cash flow challenges temporarily, but risks increasing personal debt burdens among already struggling households. Basic principles of household economics do not support taking on credit to finance routine health coverage costs—particularly when such expenses are meant to be predictable and pooled through public insurance schemes. Moreover, legal challenges have already resulted in court rulings that bar exclusion from emergency services based on insurance status, underscoring the constitutional imperative of inclusive care. For SHA to regain public confidence, there must be a renewed focus on clarity, consistency, and compassion. Equity must guide implementation just as much as fiscal planning. Universal health coverage cannot be achieved by design alone—it must be delivered through systems that align with the economic realities of those it intends to serve.

References:

The Standard Why most Kenyans cannot access SHA services

Kenyans.co.ke Kenyans Frustrated as SHA Scraps Monthly Payments, Demands Full Year Upfront

GeoPoll Understanding Kenyans’ Perception of the Social Health Authority (SHA) and Social Health Insurance Fund (SHIF)

The Star Jua Kali Kenyans paying Sh600 to SHA—double the promised rate