Dialysis and Renal Services in SHA

Introduction

The Social Health Authority (SHA) in Kenya, established under the Social Health Insurance Act of 2023, is a transformative initiative aimed at achieving Universal Health Coverage (UHC) by providing equitable access to essential healthcare services. Launched on October 1, 2024, SHA replaced the National Health Insurance Fund (NHIF) and manages three specialized funds: the Primary Health Care Fund (PHCF), Social Health Insurance Fund (SHIF), and Emergency, Chronic, and Critical Illness Fund (ECCF). Dialysis and renal services fall primarily under SHIF and ECCF, addressing chronic kidney disease (CKD) and end-stage renal disease (ESRD), which affect an estimated 4 million Kenyans, with over 20,000 requiring regular dialysis. As of September 2025, SHA has disbursed over Sh3.4 billion for renal care, including dialysis and transplants, supporting thousands of patients amid growing demand. This article provides a comprehensive overview of dialysis and renal services under SHA, including coverage details, eligibility, facilities, challenges, and impact, based on official guidelines and recent developments.

Background and Evolution from NHIF

Prior to SHA, renal care under NHIF was limited, covering up to 104 dialysis sessions annually at KSh 9,500 per session, with frequent reimbursement delays and inadequate transplant support. This left many patients facing out-of-pocket costs exceeding KSh 50,000 monthly, contributing to high mortality rates—over 10,000 CKD-related deaths yearly. The NHIF’s fragmented system often excluded informal sector workers (80% of the workforce), exacerbating inequities.

SHA’s renal care package, introduced in October 2024, expands coverage to include hemodialysis, peritoneal dialysis, hemodiafiltration, catheter insertions, and kidney transplants, aligning with the Primary Health Care Act, 2023, and constitutional rights to health (Article 43). By mid-2025, SHA has partnered with facilities like Aga Khan University Hospital for subsidized transplants and launched mobile dialysis units to reach rural areas. These reforms aim to reduce the economic burden of CKD, which costs Kenya KSh 20 billion annually in direct and indirect expenses.

Coverage Details

SHA’s renal services are comprehensive, focusing on preventive screenings, dialysis, and advanced interventions. Coverage is uniform for all members, with no caps on family dependents, unlike NHIF’s per-person limits.

Dialysis Services

• Hemodialysis: Fully covered under SHIF for up to 8 sessions per month (96 sessions annually), at KSh 10,650 per session, including labs, consultations, and medications. This is an increase from NHIF’s 104 sessions but adjusted for cost efficiency. Advanced hemodiafiltration and continuous intermittent dialysis are also included for complex cases.
• Peritoneal Dialysis: Covered at KSh 85,200 per month under SHIF, suitable for home-based treatment, reducing hospital visits.
• Emergency Dialysis: ECCF covers urgent sessions beyond SHIF limits, including during acute kidney injury.

Renal Transplant Services

• Pre-Transplant Care: Up to KSh 150,000 for evaluations, including donor matching and check-ups.
• Transplant Procedure: Covered up to KSh 700,000 under ECCF, including surgery, immunosuppression, and post-operative care. Partnerships with facilities like Aga Khan and KUTRRH subsidize costs exceeding this cap for vulnerable patients.
• Post-Transplant Support: Ongoing medications and follow-ups covered for life under SHIF, with annual reviews.

Preventive and Supportive Services

• Screenings: Free under PHCF at Levels 1-3 facilities for early CKD detection (e.g., urine tests, blood pressure monitoring).
• Chronic Management: SHIF covers consultations, erythropoietin for anemia, and nutritional support.
• Overseas Treatment: Limited to KSh 500,000 annually under ECCF for transplants unavailable locally, with a 30-day pause in 2025 for review.

Services are accessible at accredited facilities, with digital claims via Afya Yangu ensuring reimbursements within 30 days.

Eligibility and Access

Eligibility is broad and inclusive:

• Who Qualifies: All SHA-registered residents, including Kenyan citizens, non-citizens residing over 12 months, and dependents (unlimited spouses/children). CKD patients must be diagnosed by accredited providers.
• Registration: Mandatory and free via *147#, sha.go.ke, or Huduma Centres. Former NHIF members auto-transitioned but need biometric updates. Indigent patients receive full subsidies via means-testing.
• Access Process: Present SHA membership number at facilities. Referrals from PHCF to SHIF/ECCF for advanced care. No waiting periods; immediate access post-registration.
• Contributions: SHIF requires 2.75% of income (salaried) or KSh 300/month minimum (informal); ECCF is government-funded. Non-payment may delay non-emergency services.

Facilities and Infrastructure

SHA accredits over 200 facilities for renal services, including:

• Public Hospitals: Kenyatta National Hospital (KNH), Kenya University Teaching, Referral and Research Hospital (KUTRRH)—site of Kenya’s first SHA-covered transplants in May 2025—and county-level hospitals like Kirinyaga (receiving 25 new machines in 2025).
• Private and Faith-Based: Aga Khan University Hospital (MoU for subsidized transplants), Tenwek Hospital, and Bena Care in Murang’a County.
• Innovations: Mobile dialysis units in rural areas (e.g., launched March 2025) provide free sessions for SHA members, addressing access gaps.

Patients can verify facilities on sha.go.ke. As of 2025, SHA has invested in equipment upgrades, with Sh3 billion disbursed for dialysis infrastructure.

Challenges and Criticisms

Despite progress, renal services face hurdles:

• Payment Delays: Hospitals have threatened to suspend dialysis due to SHA’s delayed reimbursements (up to 90 days), leading to patients being turned away despite contributions. In June 2025, this “payment crisis” affected thousands, prompting government interventions.
• Coverage Gaps: The KSh 10,650 per session often falls short of private facility costs (KSh 15,000+), forcing out-of-pocket top-ups. Early 2025 reports noted only three sessions covered initially, though updated to eight by July.
• Access in Rural Areas: Limited machines (Kenya has ~1,500 vs. needed 5,000); mobile units help but coverage is uneven.
• Transplant Barriers: High demand (only 100+ annually) and donor shortages; overseas caps paused temporarily in August 2025.

SHA has responded with Sh1.7 billion disbursements for dialysis in August 2025 and plans for more machines.

Impact and Benefits

SHA’s renal services have improved outcomes:

• Financial Relief: Reduced costs by 50-70% for dialysis patients; e.g., monthly hemodialysis now fully covered up to KSh 85,200, vs. NHIF’s partial support.
• Increased Access: Enrollment in renal programs rose 25% in 2025, with 515,000+ CKD patients benefiting from screenings and dialysis. Successful transplants at KUTRRH (two in May 2025) mark a milestone.
• Health Outcomes: Reduced CKD mortality by 15% through early intervention; mobile units in rural Kenya have served thousands since March 2025.
• Equity: Subsidies ensure 70% of beneficiaries are low-income, boosting informal sector uptake to 30%.

GeoPoll’s 2025 survey shows 55% satisfaction with renal coverage, though delays remain a concern.

Future Outlook

SHA plans to expand renal services by:

• Acquiring 500+ dialysis machines by 2026, including county-level upgrades like Kirinyaga’s 25 units.
• Increasing ECCF funding to Sh8 billion for transplants and advanced care.
• Integrating AI diagnostics via Afya Yangu for CKD screening.
• Strengthening MoUs for local transplants, reducing overseas reliance.

By 2030, SHA aims for full UHC, potentially covering 5,000+ dialysis sessions daily.

Conclusion

Dialysis and renal services under SHA represent a lifeline for CKD patients, offering expanded coverage for hemodialysis (up to 8 sessions/month), peritoneal dialysis, and transplants (up to KSh 700,000). Through SHIF and ECCF, SHA ensures affordability and access via accredited facilities and innovations like mobile units. While challenges like payment delays persist, recent disbursements and infrastructure investments signal commitment. For Kenyans with renal needs, prompt SHA registration unlocks these benefits, fostering a more equitable healthcare system.

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