Tag Archives: healthcare

The Impact of SHA on Health Access in Kenya

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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.

A Report by K24TV

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

Fake Medicines Threaten Public Health in Kenya

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Kenya’s pharmaceutical supply chain is facing a creeping, deadly crisis — one that’s quietly poisoning public trust in healthcare. In 2024 alone, over 30 different drug products were recalled in Kenya, more than doubling the previous year’s figure. This disturbing surge included contaminated pediatric syrups, mislabeled antibiotics, and packaging mix-ups between life-saving cancer drugs and common generics. Some of these were produced by global manufacturers with once-reputable names. The growing scale and severity of these incidents have exposed glaring weaknesses in regulatory enforcement, border control, and supply chain oversight. But beyond the headlines lies a darker story — fake and substandard medicines are no longer rare exceptions; they are becoming routine features in pharmacies, clinics, and even households. As treatment failures rise and drug resistance intensifies, trust in medicine itself is breaking down. Patients increasingly worry: if I walk into a pharmacy, how can I know what I’m buying won’t kill me?

A K24 Report from 2024

The regulator, the Pharmacy and Poisons Board (PPB), is overwhelmed. With just 16 inspectors tasked with overseeing a vast and evolving market — spanning over 10,000 retail outlets, mobile vendors, and now, an unregulated e-pharmacy explosion — enforcement efforts are falling behind. In 2024, the PPB shut down 117 illegal pharmacies, an important but ultimately symbolic move in the face of thousands more operating without licenses or pharmacist supervision. Online drug sales are the new front line. A study found that over 60% of Kenyan e-pharmacies sell restricted drugs like antibiotics and sedatives without prescriptions, bypassing safeguards entirely. These platforms, often disguised as Instagram shops, WhatsApp-based vendors, or websites with fake credentials, target desperate buyers looking for cheap, fast relief. With little digital verification, no pharmacist involvement, and no legal framework to manage or penalize them, the risk of mass harm is escalating. Meanwhile, legitimate pharmacies face the fallout: eroded consumer confidence, a rise in self-medication, and unfair competition from black-market sellers. At the center of it all is a poorly resourced regulator trapped in a battle it cannot win with its current tools.

Fixing this won’t come from a few more closures or stern warnings. What’s needed is a total overhaul of pharmaceutical regulation and public health literacy. The PPB needs financial and legal independence, an expanded workforce, and modern tools — including barcode authentication, blockchain-backed tracking systems, and real-time reporting dashboards for drug recalls and falsifications. E-pharmacies must be brought under legal oversight immediately, with criminal penalties for non-compliant platforms. Consumer protection should no longer be passive; the government must launch aggressive national awareness campaigns to teach people how to identify fake drugs, report suspicious sources, and verify prescriptions. Crucially, Kenya must repair public trust — not just in the pills on pharmacy shelves, but in the very systems meant to safeguard their health. Because when faith in medicine collapses, people don’t stop getting sick — they just stop getting help. This is more than a regulatory failure. It’s a national health emergency — and one that cannot be ignored.

References:

The Eastleigh Voice Inside Kenya’s battle against fake and unsafe medicines

Eurek Alert Curbing harmful medicines: the promise of a unified African health products regulatory system

OECD Dangerous Fakes


Kenya’s Healthcare Financing: SHA Performance Review

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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 Report by Citizen Digital

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

Kenya’s Health Challenges Post-Trump’s WHO Departure

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The decision by U.S. President Donald Trump to withdraw from the World Health Organization (WHO) represents a substantial shift in American foreign policy, with potentially profound implications for global health dynamics. This withdrawal was one of Trump’s first actions upon returning to office, formalized through an executive order that signals a marked departure from the international cooperation that had been a hallmark of the previous administration. The move reflects Trump’s broader nationalist approach, which prioritizes America’s sovereignty over multilateral engagements and echoes his longstanding criticisms of the WHO. This shift stands as a stark contrast to the efforts aimed at fostering global health solidarity, as historically represented by WHO-led initiatives like the eradication of smallpox, significant strides against polio, and its essential interventions in health crises such as Ebola and COVID-19. The WHO has been a crucial entity for developing nations including Kenya, offering much-needed access to health expertise, resources, and coordination in combating endemic diseases and enhancing public health infrastructures. Trump’s executive order to cut ties with the WHO risks undermining these collaborative international networks, potentially stalling vital health programs and challenging Kenya’s ability to maintain and build on recent advancements in its health sector without the backing of global assistance.

CTV News Report

The long-standing partnership between the WHO and USAID in Kenya serves as a testament to the impact of collaborative global health efforts. Through initiatives like the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. has provided expansive funding, while the WHO has aligned Kenya’s health programs with global standards, offering invaluable technical guidance. This dual support system has been instrumental in the fight against HIV/AIDS, malaria, and maternal and child health issues, resulting in favorable health outcomes such as reduced HIV prevalence and improved maternal health indicators. Kenya’s aim to achieve the UNAIDS 95-95-95 targets—an ambitious goal focused on extensive HIV testing, treatment accessibility, and viral load suppression—highlights the indispensable role of such collaborations. However, Trump’s policy of withdrawal injects uncertainty into these programs, with risks including disrupted supply chains for antiretrovirals, stunted malaria prevention initiatives, and weakened maternal health services. The potential delay in emergency responses and compromised disease surveillance capabilities further complicate Kenya’s health landscape, underscoring the need for a steadfast strategic realignment to navigate these challenges.

In its strategic response to the withdrawal and its implications, Kenya must pivot towards strengthening regional health bodies and seeking new partnerships to buffer the impact of lost support. Institutions like the Africa Centers for Disease Control and Prevention (CDC), as well as Kenya’s own Ministry of Health, can play pivotal roles in fostering continental and national self-reliance, reducing dependency on traditional Western aid. By actively pursuing partnerships with alternative global players such as the European Union, China, and philanthropic organizations like the Bill and Melinda Gates Foundation, Kenya can bridge financial gaps and ensure continuity in health service delivery. Moreover, increasing domestic investment in healthcare becomes crucial to building resilience and sustainability in local health systems. Regional alliances, particularly under the umbrella of the East African Community (EAC), present opportunities for shared resources and collaborative health solutions, reinforcing the region’s capability to tackle shared health challenges. This strategic recalibration not only allows Kenya to maintain its public health initiatives amid global political shifts but also positions it to advocate for more inclusive and equitable global health policies. In the broader context, the move away from multilateralism, as reflected in Trump’s policy, challenges Kenya and similarly positioned nations to reframe their health priorities, ensuring that progress is not undermined by geopolitical tensions and resource insecurities.

References:

U.S. EMBASSY IN KENYA PEPFAR in Kenya

NTV Kenya Trump era stirs concern in Kenya over aid and policy shifts

CHIMP Reports How Trump’s Withdrawal of U.S. from WHO will Affect Africa

Reuters Trump orders US exit from World Health Organization

The Standard WHO ‘regrets’ US decision to withdraw from organisation

BBC US exit from WHO could see fifth of budget disappear

Time What Leaving the WHO Means for the U.S and the World

The Guardian ‘Sowing seeds for next pandemic’: Trump order for US to exit WHO prompts alarm

CNN What is the World Health Organization and why does Trump want to leave it?