Maternity Care Covered by SHA

Introduction

The Social Health Authority (SHA) in Kenya, established under the Social Health Insurance Act of 2023, represents a major overhaul of the country’s healthcare system to achieve Universal Health Coverage (UHC). Replacing the National Health Insurance Fund (NHIF), SHA manages three funds—Primary Health Care Fund (PHCF), Social Health Insurance Fund (SHIF), and Emergency, Chronic, and Critical Illness Fund (ECCF)—to provide equitable access to healthcare. Maternity care under SHA builds on and expands the former Linda Mama program, offering comprehensive support for antenatal, delivery, postnatal, and neonatal services. As of September 2025, SHA has supported over 515,000 deliveries since its launch in October 2024, significantly reducing maternal mortality risks and financial burdens for families. This revamped approach ensures free primary-level services and subsidized hospital care, addressing gaps in NHIF’s coverage, which often required out-of-pocket payments. This article explores SHA’s maternity benefits, eligibility, access, challenges, and impact, drawing on official guidelines and recent data.

Background and Evolution from NHIF

Under NHIF, maternity services were provided through the Linda Mama program, launched in 2017, which offered free antenatal, delivery, and postnatal care to reduce Kenya’s maternal mortality ratio (355 deaths per 100,000 live births, per UNFPA data). However, coverage was limited: normal deliveries were capped at KSh 10,000, cesarean sections (C-sections) at varying rates, and services were often restricted to contracted facilities with co-payments. Informal sector enrollment was low (20%), leaving many vulnerable women underserved.

SHA integrates and expands Linda Mama into its framework, making maternity care a core benefit across funds. The Primary Health Care Act, 2023, emphasizes community-level services, while SHIF handles hospital-based care. As of 2025, the revamped Linda Mama offers broader benefits, including enhanced screenings and referrals, supported by over 100,000 Community Health Promoters (CHPs). This aligns with Kenya’s goal to meet WHO standards, where C-section rates have exceeded recommendations (estimated 9.2% in Africa), prompting better monitoring under SHA.

Funds Involved in Maternity Care

SHA’s tripartite structure ensures layered maternity support:

• Primary Health Care Fund (PHCF): Fully government-funded (KSh 10 billion in 2024/25), covering free antenatal, postnatal, and basic delivery services at Levels 1-3 facilities (community units, dispensaries, health centers). No individual contributions required.
• Social Health Insurance Fund (SHIF): Contribution-based (2.75% of income for salaried; minimum KSh 300/month for informal sector), funding hospital deliveries and specialized maternity care at Levels 4-6 (county and referral hospitals). Subsidies cover indigent women.
• Emergency, Chronic, and Critical Illness Fund (ECCF): Government-funded for maternity emergencies (e.g., eclampsia, hemorrhage), activating after SHIF exhaustion. Includes critical neonatal care.

This structure promotes preventive care at grassroots levels while ensuring hospital support for complications.

Detailed Coverage of Maternity Services

SHA provides a uniform maternity benefit package, emphasizing holistic care without family caps or waiting periods. Services are accessible at over 10,000 accredited facilities, with digital tools like Afya Yangu facilitating appointments and records.

Antenatal Care

• Free under PHCF at Levels 1-3: Includes routine check-ups, ultrasounds, blood tests (e.g., hemoglobin, HIV, syphilis), nutritional counseling, and vaccinations (tetanus toxoid).
• Specialized antenatal at Levels 4-6 via SHIF: For high-risk pregnancies (e.g., gestational diabetes, preeclampsia), with no co-payments.
• Additional supports: Iron/folic acid supplements, malaria prophylaxis in endemic areas, and mental health screenings.

Delivery Services

• Normal Delivery: Covered at KSh 10,000 under SHIF, including midwifery, labor ward, pain management, and immediate postnatal monitoring. Free at selected Level 4 facilities under PHCF.
• Cesarean Section (C-Section): Covered at KSh 30,000, including operating theater, anesthesia, recovery room, and emergency interventions (e.g., tranexamic acid for hemorrhage, magnesium sulfate for eclampsia). Fully covered in public hospitals with minimal additional costs.
• Hospital Stay: 2 days for normal delivery, 3 days for C-section, at KSh 2,240 per day for Level 3 facilities, with a household limit of 180 days/year.
• Other Inclusions: Meals, special diets, newborn immunization, diagnostic tests, medical supplies, and equipment.

Postnatal Care

• Free under PHCF: Includes wound care, breastfeeding support, family planning counseling, and newborn screenings (e.g., hearing, congenital conditions).
• SHIF Coverage: For complications like postpartum hemorrhage or infections, with follow-up specialist visits.
• Neonatal Care: Comprehensive under SHIF/ECCF, including neonatal ICU for premature babies, phototherapy for jaundice, and specialized newborn care.

Additional Supports

• Emergency Maternity: ECCF covers life-threatening issues like ectopic pregnancy or severe preeclampsia.
• Mental Health: Perinatal depression screening and counseling integrated into maternity services.
• Assistive Devices: For disabilities arising from pregnancy complications.

Eligibility, Registration, and Access

• Eligibility: All registered SHA members, including pregnant women as principals or dependents. Non-citizens residing over 12 months qualify. Indigent women receive full subsidies.
• Registration: Free and mandatory via *147#, sha.go.ke, or Huduma Centres. Newborns registered within 14 days using principal’s membership. Pregnant teens can register with birth certificates.
• Access: Use SHA number at facilities. CHPs provide home-based antenatal visits and referrals. Afya Yangu app tracks appointments and records. No co-payments for covered services; pre-approval for overseas maternity-related care (rare).

Comparison with NHIF

SHA eliminates caps and extends coverage, supporting more deliveries (515,000 vs. NHIF’s lower reach).

Challenges and Public Perception

Despite advancements, challenges persist:

• Access for Vulnerable Groups: Pregnant teenagers face barriers like lack of parental support or documentation, though SHA allows birth certificate registration.
• Awareness and Affordability: GeoPoll’s 2025 survey indicates 40% of rural women unaware of SHA maternity benefits; informal sector contributions (KSh 3,600/year) strain low-income families, mitigated by subsidies.
• Facility Readiness: Some rural areas lack equipped Levels 4-6 facilities; SHA is addressing this through infrastructure upgrades.
• C-Section Rates: High rates (exceeding WHO limits) raise concerns; SHA promotes monitoring to prevent unnecessary procedures.

Public perception is positive, with 60% viewing SHA as improving maternal health, per GeoPoll.

Impact and Future Outlook

SHA’s maternity care has delivered tangible impacts: Over 515,000 deliveries supported, with 4.5 million accessing basic care. In counties like Uasin Gishu, 80% of mothers deliver in facilities, boosting outcomes. Reduced financial barriers have lowered maternal mortality risks, aligning with SDG 3.

Future plans include expanding CHP coverage, increasing PHCF budgets, and integrating AI for prenatal monitoring via Afya Yangu. By 2030, SHA aims for full UHC, further enhancing maternity services.

Conclusion

SHA’s maternity care is a comprehensive, equitable system that integrates preventive and hospital-based services, far surpassing NHIF’s offerings. By providing free antenatal/postnatal care under PHCF and subsidized deliveries under SHIF, SHA protects mothers and newborns from financial hardship. While challenges like awareness and access for vulnerable groups remain, ongoing reforms and high delivery numbers signal progress. Pregnant women are encouraged to register promptly to access these life-saving benefits, contributing to a healthier Kenya.

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