Overview of the Social Health Authority in Kenya
Introduction
The Social Health Authority (SHA) is a pivotal state corporation in Kenya’s healthcare landscape, designed to advance Universal Health Coverage (UHC) by managing social health insurance and ensuring equitable access to quality healthcare services. Established as part of comprehensive health reforms, the SHA aims to address longstanding gaps in the country’s health financing system, such as low coverage rates and financial barriers to care. By pooling resources and providing financial protection, the SHA seeks to make healthcare affordable and accessible for all Kenyans, regardless of socioeconomic status. As of September 2025, nearly a year after its official launch, the SHA continues to transition from the previous National Hospital Insurance Fund (NHIF) while navigating implementation challenges.
Background and Establishment
Kenya’s journey toward UHC has been marked by efforts to reform its fragmented health system. Prior to the SHA, the NHIF served as the primary public health insurer but faced criticism for limited coverage—only about 26% of the population was enrolled as of 2023, with even lower rates among the informal sector (around 27%) and the economically disadvantaged (less than 5%). Inefficiencies, corruption allegations, and inadequate benefits further eroded public trust.
The SHA was established to rectify these issues, officially launching on October 1, 2024. This followed the signing of key legislation in 2023, aligning with President William Ruto’s manifesto commitments to create a more inclusive insurance scheme. The transition from the NHIF began on November 22, 2023, with a dedicated Transition Committee formed in February 2024 to oversee the process, including the transfer of assets, liabilities, contracts, and staff within 12 months. The NHIF was wound up by July 2024, ensuring service continuity during the handover.
The SHA operates under the Ministry of Health, with its headquarters at Afya House, Cathedral Road, Nairobi. Its creation reflects Kenya’s constitutional mandate for the right to the highest attainable standards of health, emphasizing prevention, promotion, curative, rehabilitative, and palliative care without financial hardship.
Legal Framework
The SHA is governed by the Social Health Insurance Act, 2023, which abolishes the NHIF and establishes the authority as the sole manager of social health insurance. Complementary laws include the Digital Health Act, 2023 (for secure health data management), the Facility Improvement Financing Act, 2023 (for facility upgrades), and the Primary Health Care Networks Act, 2023 (for community-level services). These reforms strengthen health financing, service delivery, and digital integration to support UHC.
The Social Health Insurance (General) Regulations, 2024, further detail operational aspects, such as benefit packages, tariffs, and provider accreditation. Registration and contributions are mandatory for all residents, with penalties for non-compliance, underscoring the system’s equity principles.
Governance and Structure
As a state corporation, the SHA is led by a Board of Directors, chaired by Dr. Mohammed Abdi Mohammed. The board oversees strategic direction, policy formulation, and oversight, with recent appointments in September 2025 strengthening leadership. Four new directors were added through a competitive process: Diana Marion (Director, Provider and Beneficiary Management), Golda Larissa (another director role), and others focused on operations and compliance.
Dr. Mercy Mwangangi serves as the Chief Executive Officer (CEO), appointed in a move to bolster expertise in public health administration; she previously held roles as Chief Administrative Secretary in the Ministry of Health. Prior to her appointment, Robert Ingasira acted as CEO. The board facilitates annual evaluations, governance audits, and work plans to ensure transparency and accountability.
The SHA’s structure includes departments for provider management, beneficiary services, finance, and digital health. It accredits healthcare providers (public, private, and faith-based) and publishes lists on its website (sha.go.ke). A complaints resolution mechanism, aligned with the Mwongozo Code of Governance, handles disputes, while procurement follows Public Procurement and Asset Disposal Act guidelines.
Managed Funds
The SHA administers three distinct funds, each targeting specific aspects of healthcare to promote comprehensive coverage:
| Fund Name | Purpose | Funding Sources | Key Coverage |
|---|---|---|---|
| Social Health Insurance Fund (SHIF) | Provides financial protection for inpatient and outpatient services at higher-level facilities (Levels 4-6). Aims to expand coverage to all Kenyans through risk pooling. | Mandatory contributions (2.75% of income), employer deductions, and government subsidies. | Enhanced benefits over NHIF, including referrals to empaneled providers; no caps on family dependents. |
| Primary Health Care Fund (PHCF) | Supports essential preventive and primary services at community levels (Levels 1-3), including referrals from community health promoters. | Government allocations, grants, and taxes (no individual contributions). | Free treatment at dispensaries, health centers, and sub-county hospitals. |
| Emergency, Chronic, and Critical Illness Fund (ECCF) | Covers costs for emergencies, chronic conditions (e.g., dialysis, cancer), and critical care after SHIF limits are exhausted. | Public funding via government budgets and donations. | Specified services in the Fourth Schedule of SHI Regulations, 2024, such as organ transplants and intensive care. |
These funds ensure a layered approach: PHCF for basics, SHIF for standard care, and ECCF for advanced needs.
Functions and Responsibilities
The SHA’s core functions include:
- Registration and Enrollment: Mandatory for all residents (Kenyans and non-Kenyans staying over 12 months). Requires national ID and biometrics; newborns must register within 14 days. Former NHIF members are automatically transitioned.
- Contribution Collection: Deducts 2.75% from salaries; informal sector pays annually via means-testing (minimum Ksh 300/month). Government subsidizes the indigent.
- Provider Accreditation and Contracting: Empanels facilities and issues e-contracts; providers must reapply under SHA standards.
- Claims Processing and Payments: Manages reimbursements to providers, with digital tools for efficiency.
- Benefit Management: Defines and updates the Essential Benefits Package via the Benefits and Tariffs Authority.
- Fraud Detection and Oversight: Emphasizes anti-corruption measures, as urged by Health Cabinet Secretary Aden Duale in June 2025.
- Data and Records Management: Maintains medical records, especially for overseas services.
The SHA also collaborates with counties for preventive care and ensures no waiting periods for services.
Contributions and Registration
Contributions are income-based and mandatory, promoting equity. Salaried workers face automatic payroll deductions; self-employed individuals register via SHA portals or Huduma centers. Income changes must be reported for rate adjustments. Late payments incur a 2% penalty. Registration is free and online/offline, with unlimited dependents (spouses and children) covered under one principal member.
Benefits and Services
All members receive a uniform benefit package, eliminating disparities between formal and informal sectors. Benefits include:
- Free primary care via PHCF.
- Comprehensive secondary/tertiary care via SHIF (e.g., maternity, surgeries).
- Catastrophic coverage via ECCF (e.g., chemotherapy, emergencies).
Services are accessible at accredited facilities nationwide, with referrals ensuring appropriate care levels. Compared to NHIF, SHA offers more explicit benefits and no reimbursement caps for families.
Key Initiatives
A flagship initiative is Afya Yangu, a digital platform under the SHA and Ministry of Health. It enables users to manage medical records, track insurance, schedule appointments, update health profiles, and access prescriptions. Pre-registration is available at sha.go.ke/afya/pre-register, promoting patient empowerment and data security under the Digital Health Act.
Other efforts include e-contracting for providers and public awareness campaigns to boost enrollment.
Challenges and Public Perception
Despite its ambitions, the SHA faces hurdles. Public perception surveys, such as GeoPoll’s March 2025 study, show high awareness but concerns over affordability (2.75% contributions seen as burdensome for low-income groups) and accessibility, particularly in rural areas. Corruption remains a flashpoint; a March 2025 Auditor General’s report highlighted unbudgeted procurement of the SHA system via non-competitive processes, breaching laws and fueling skepticism.
Implementation issues include delayed payments to providers, limited coverage for certain services (e.g., some mental health or specialized treatments), and exclusion of the unemployed/indigent, leading to hospital denials. Past NHIF scandals amplify distrust, with calls for stronger accountability. Enrollment lags, with only partial success in informal sector uptake.
Conclusion and Future Outlook
The Social Health Authority represents a bold step toward UHC in Kenya, centralizing health financing to protect citizens from medical poverty. By managing pooled funds and leveraging digital tools like Afya Yangu, it has the potential to transform healthcare delivery. However, addressing corruption, enhancing subsidies, and improving outreach are crucial for success. As Kenya monitors progress toward full coverage by 2030, ongoing reforms—such as the forthcoming Quality of Care Bill—will be essential. With transparent governance and stakeholder engagement, the SHA can fulfill its mandate of healthier, more equitable future for all Kenyans.
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