Using the Afya Yangu Platform for SHA

Introduction

The Social Health Authority (SHA), established under the Social Health Insurance Act of 2023, is Kenya’s cornerstone for achieving Universal Health Coverage (UHC), replacing the National Health Insurance Fund (NHIF) as of October 1, 2024. 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 healthcare access to over 26 million enrolled Kenyans as of September 20, 2025. Central to SHA’s operations is the Afya Yangu platform, a web-based and mobile application system accessible via sha.go.ke and integrated with the *147# USSD code. Afya Yangu streamlines registration, facility searches, claims processing, and benefit tracking, enabling efficient management of SHA coverage. By July 2025, SHA disbursed KSh 551 billion to providers, with 80% of claims processed electronically through Afya Yangu, a significant improvement over NHIF’s 90+ day manual delays. This article provides a comprehensive guide to using the Afya Yangu platform for SHA, detailing its features, user processes, benefits, challenges, success stories, and future enhancements, based on official regulations and data as of September 20, 2025, 10:44 AM EAT.

Background: From NHIF to SHA’s Digital Transformation

Under NHIF, healthcare management relied on manual processes, leading to significant inefficiencies:

• Delayed Claims: Reimbursement lags of 90–180 days resulted in KSh 33 billion in arrears by 2023, straining providers.
• Fraud: Ghost claims, such as KSh 2.5 billion in 2022, eroded trust.
• Low Enrollment: Only 26% of Kenyans were covered, with 20% informal sector uptake, limiting access.
• Access Barriers: Paper-based registration and claims restricted efficiency, especially in rural areas.

SHA’s digital-first approach, mandated by the Social Health Insurance (General) Regulations, 2024, leverages Afya Yangu to address these gaps. The platform supports Kenya’s Health Policy 2017–2030 and Article 43 of the Constitution (right to health) by enabling seamless enrollment, claims, and service access. By September 2025, Afya Yangu has facilitated 70% population coverage (26 million), with 4.5 million primary care visits and 2.2 million specialized services, reducing out-of-pocket costs by 40% (previously 26% of health expenditures).

Features of the Afya Yangu Platform

Afya Yangu is a multifaceted digital tool designed for both beneficiaries and healthcare providers, integrating with *147# USSD for accessibility. Key features include:

1. Registration and Enrollment

• Function: Allows individuals to register for SHA membership using national ID, passport, birth certificates (for minors), or refugee documents.
• Process: Users access sha.go.ke or the Afya Yangu app, input personal details, and complete biometric verification (fingerprint or facial recognition). Community Health Promoters (CHPs) assist non-digital users.
• Means-Testing: Informal sector members undergo income assessment to determine contributions (2.75% of income, minimum KSh 300/month), with subsidies for indigent households.
• Impact: Over 26 million enrolled by September 2025, with 70% of low-income households and 90,000 Inua Jamii beneficiaries onboarded via Afya Yangu.

2. Facility Locator

• Function: Lists over 10,000 SHA-accredited facilities (8,000 Levels 1-3, 2,000 Levels 4-6), including public, private, and faith-based providers.
• Process: Users search by location, facility level, or service (e.g., dialysis, maternity) to find nearby providers like Kenyatta National Hospital (KNH) or Aga Khan.
• Impact: Enabled 4.5 million primary care visits by July 2025, with 70% of searches in rural areas facilitated by CHPs.

3. Claims Submission and Processing

• Function: Providers submit electronic claims within seven days of service or discharge, with SHA reviewing within 72 hours and paying within 30 days.
• Process:
• Providers enter patient SHA number, procedure codes (ICD-11), invoices, and medical reports (e.g., lab results, discharge summaries).
• Pre-approval for high-cost services (e.g., KSh 700,000 kidney transplants) is requested via the platform.
• SHA audits for tariff compliance (e.g., KSh 30,000 for cesarean) and rejects non-compliant claims (20% in Q1 2025).
• Impact: KSh 551 billion disbursed by July 2025, with 80% of claims processed electronically, reducing NHIF’s 90+ day delays.

4. Benefit Tracking

• Function: Allows members to view coverage details, including PHCF (free primary care), SHIF (e.g., KSh 300,000/year for oncology), and ECCF (e.g., KSh 500,000 overseas cap).
• Process: Users log in with their SHA number to check eligibility, contribution status, and service limits.
• Impact: Enhanced transparency, with 60% of urban users accessing benefit details by mid-2025.

5. Contribution Management

• Function: Facilitates SHIF payments (2.75% of income or KSh 300/month) via mobile money (e.g., M-Pesa) or bank transfers.
• Process: Users pay through Afya Yangu or *147#, with subsidies auto-applied for 1.5 million indigent households (September 2025).
• Impact: Streamlined payments for 70% of informal sector members, with government covering premiums for 1.5 million indigent.

6. Feedback and Support

• Function: Provides a portal for disputes, appeals, and inquiries, with a toll-free line (0800 720 601) and email (customercare@sha.go.ke).
• Process: Users report issues (e.g., claim rejections) or appeal within 14 days, with SHA responding within 72 hours.
• Impact: Reduced disputes, with 80% of rejection notices issued electronically by September 2025.

How to Use the Afya Yangu Platform

For Beneficiaries

1. Register:

• Visit sha.go.ke or download the Afya Yangu app (available on Google Play/App Store).
• Enter ID, passport, or alternative documents; complete biometric verification.
• Informal sector users undergo means-testing via the platform or CHPs.
• Example: A Kibera resident registered in 2025 using *147#, accessing free PHCF screenings.

1. Verify Contributions:

• Check SHIF payment status (KSh 300/month minimum) via Afya Yangu or *147#.
• Confirm subsidies for indigent status (e.g., Inua Jamii beneficiaries).

1. Locate Facilities:

• Search for accredited facilities (e.g., KNH for oncology, dispensaries for screenings) by location or service.
• Example: A Mombasa resident used Afya Yangu to find Coast General Hospital for dialysis.

1. Track Benefits:

• Log in to view coverage (e.g., KSh 10,650/dialysis session, KSh 28,000/day ICU).
• Example: A Nairobi patient confirmed KSh 300,000 oncology coverage at KUTRRH in 2024.

1. File Complaints:

• Report issues (e.g., service denials) via the platform or 0800 720 601.

For Healthcare Providers

1. Verify Accreditation:

• Confirm SHA empanelment via sha.go.ke, ensuring KMPDC licensing.
• Example: Mbagathi Hospital verified accreditation for SHIF maternity services.

1. Check Patient Eligibility:

• Enter patient SHA number to confirm membership and contribution status.
• Example: KUTRRH verified 61 chemotherapy patients’ eligibility in October 2024.

1. Submit Claims:

• File within seven days via Afya Yangu, including ICD-11 codes, invoices, and reports.
• Request pre-approval for ECCF services (e.g., transplants).
• Example: KNH submitted KSh 70 million in claims in August 2025.

1. Track Payments:

• Monitor claim status and payments (targeted within 30 days).
• Appeal rejections within 14 days via the platform.

Benefits of Afya Yangu

• Efficiency: 80% of claims processed electronically, with 30-day payments vs. NHIF’s 90+ days.
• Accessibility: Over 10,000 facilities accessible, with 4.5 million primary care visits by July 2025.
• Fraud Reduction: Biometric verification and audits cut ghost claims by 15% in 2025.
• Equity: Subsidies for 1.5 million indigent households (September 2025) managed via Afya Yangu, with 70% of beneficiaries low-income.
• Transparency: Real-time benefit and claim tracking, with 72-hour rejection notices.

Success Stories

1. Kibera, Nairobi: A single mother used Afya Yangu to register and locate Mbagathi Hospital for a KSh 30,000 cesarean in 2025, saving KSh 50,000, per a Ministry briefing.
2. Turkana County: A CHP used Afya Yangu tablets to enroll a nomadic family, accessing ECCF-funded ICU care (KSh 28,000/day) in 2025, as shared during President Ruto’s September 13, 2025, meeting.
3. KUTRRH, Nairobi: A cancer patient confirmed KSh 300,000 SHIF coverage via Afya Yangu, receiving chemotherapy in 2024, per KUTRRH’s October report.

Challenges

• Rural Connectivity: Limited internet in ASAL regions hinders Afya Yangu use, with 35% of rural users unaware of benefits, per GeoPoll 2025.
• System Bugs: Early eClaims failures caused 20% claim rejections in Q1 2025, prompting RUPHA’s September 2025 go-slow notice.
• Arrears: KSh 43 billion in unpaid dues by August 2025 disrupt providers.
• Digital Literacy: Low smartphone penetration limits app access, though *147# mitigates this.
• Fraud Risks: System errors reinstated non-compliant facilities, per RUPHA’s critique.

Reforms and Solutions

• Digital Fixes: September 2025 upgrades resolved eClaims bugs, with 80% electronic processing.
• Rural Access: KSh 500 million allocated for ASAL connectivity in 2025.
• CHP Support: 100,000 CHPs equipped with tablets assist non-digital users.
• Anti-Fraud: AI audits and biometrics reduced fraud by 15% in 2025.
• Arrears Clearance: Monthly disbursements target KSh 43 billion clearance by 2026.

Future Outlook

SHA plans to:

• Achieve 100% digital claims by 2027, with AI diagnostics via Afya Yangu.
• Expand *147# for telehealth by 2026.
• Increase funding (PHCF to KSh 15 billion, ECCF to KSh 8 billion by 2026/27).
• Deploy 500 mobile clinics with digital connectivity by 2027.

Conclusion

The Afya Yangu platform is SHA’s digital backbone, enabling 26 million Kenyans to access registration, facility searches, and claims management. Success stories from Kibera, Turkana, and KUTRRH highlight its role in reducing costs and improving outcomes. Challenges like rural connectivity and arrears persist, but 2025 reforms signal progress. Users should engage via sha.go.ke, *147#, or CHPs to leverage Afya Yangu, advancing Kenya’s UHC vision by 2030.

SARABI MAISHA MAGIC PLUS SEASON 1 EPISODE 88