Public Facilities Integrated with 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, affordable healthcare to over 26 million enrolled Kenyans as of September 20, 2025. Public healthcare facilities, including community units, dispensaries, health centers, and referral hospitals, form the backbone of SHA’s network, serving both urban and rural populations. With over 8,000 public facilities integrated into SHA’s system, they handle the majority of the 4.5 million primary care and 2.2 million specialized care visits recorded by July 2025. Despite challenges such as reimbursement delays and infrastructure gaps, public facilities are pivotal in reducing out-of-pocket costs (previously 26% of health expenditures under NHIF) and advancing UHC. This article provides a comprehensive overview of public facilities integrated with SHA, detailing their roles, accreditation, key examples, benefits, challenges, and recent developments, based on official regulations and data as of September 20, 2025, 10:27 AM EAT.

Background: Public Facilities and the Transition from NHIF to SHA

Public healthcare facilities in Kenya, managed by county and national governments, serve approximately 80% of the population, particularly low-income and rural communities. Under NHIF, public facilities faced significant challenges:

• Limited Coverage: NHIF’s 26% enrollment rate by 2023 left many uninsured, with caps (e.g., KSh 400,000/year for inpatient care) forcing out-of-pocket payments that pushed 1.5 million into poverty annually.
• Reimbursement Delays: Delays of 90–180 days led to KSh 33 billion in NHIF arrears, straining facility operations.
• Infrastructure Gaps: Many Level 1-3 facilities lacked equipment, and only 500 surgeons served 54 million people, limiting specialized care.
• Urban-Rural Disparities: Urban hospitals like Kenyatta National Hospital (KNH) were overburdened, while rural facilities struggled with access.

SHA’s launch in October 2024 introduced a digital-first, inclusive model with progressive contributions (2.75% of income, minimum KSh 300/month) and subsidies for 1.5 million indigent households, as announced by President William Ruto on September 13, 2025. By July 2025, SHA disbursed KSh 551 billion to providers, with public facilities receiving significant allocations (e.g., KSh 70 million to KNH in August 2025). The integration of public facilities into SHA’s network, supported by the Afya Yangu platform, aims to streamline claims and enhance service delivery, particularly for the 70% of Kenyans in rural areas.

Accreditation Process for Public Facilities

Public facilities must meet SHA’s accreditation standards to participate in the network, ensuring quality and compliance with UHC goals:

• Licensing by KMPDC: The Kenya Medical Practitioners and Dentists Council (KMPDC) licenses all public facilities, with over 8,000 registered by June 2025. Facilities are classified by level:
• Level 1: Community units for health promotion.
• Level 2-3: Dispensaries and health centers for primary care.
• Level 4-5: County hospitals for inpatient/outpatient care.
• Level 6: National referral hospitals for specialized care.
• SHA Contracting: Facilities apply via sha.go.ke, submitting proof of KMPDC licensing, staffing (e.g., doctors, nurses), equipment (e.g., X-ray machines, ICU beds), and tariff compliance. By October 2024, 95% of public facilities completed e-contracting, compared to 42% of private hospitals.
• Quality Standards: SHA audits ensure compliance with WHO guidelines and tariff adherence (e.g., KSh 10,000 for normal delivery). Non-compliant facilities face suspension, as seen with some rural dispensaries in 2025.
• Re-accreditation: Annual reviews by SHA’s Benefits Package and Tariffs Advisory Panel (BPTAP), inaugurated in May 2025, ensure ongoing compliance.

Accreditation enables public facilities to access capitation (PHCF) and fee-for-service (SHIF/ECCF) reimbursements, processed within 30 days via Afya Yangu.

Key Public Facilities in the SHA Network

SHA’s network includes over 8,000 public facilities, with notable examples across levels:

National Referral Hospitals (Level 6)

• Kenyatta National Hospital (KNH), Nairobi: Kenya’s largest referral hospital, handling 1.5 million patients annually. SHA-accredited for oncology, dialysis, and ICU care, KNH received KSh 70 million in August 2025 for specialized services.
• Moi Teaching and Referral Hospital (MTRH), Eldoret: Serves western Kenya with SHA-funded cardiology and renal care, treating 39 dialysis patients by October 2024.
• Kenyatta University Teaching, Referral & Research Hospital (KUTRRH): Fully SHA-accredited, treated 61 chemotherapy and 10 endoscopy patients by October 2024, focusing on NCDs.

County Hospitals (Level 4-5)

• Mbagathi Hospital, Nairobi: Provides SHA-funded maternity (KSh 30,000 for cesarean) and outpatient care, serving informal settlements like Kibera.
• Coast General Teaching and Referral Hospital, Mombasa: Offers renal and emergency care under ECCF, with SHA covering ambulance services (KSh 5,000–10,000/trip).
• Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu: SHA-accredited for surgeries and chronic care, serving Nyanza region.
• Ol Kalou Hospital, Nyandarua: Supports 43% of county residents under SHA, offering subsidized maternity and dialysis.

Primary Care Facilities (Level 1-3)

• Dispensaries and Health Centers: Over 6,000 rural and urban units (e.g., in Turkana, Nyandarua) provide free PHCF services like screenings and vaccinations. For example, 4.5 million accessed primary care by July 2025.
• Community Units: Managed by CHPs, these deliver health promotion in informal settlements and rural areas, reaching 70% of households.

Nationwide, SHA accredits 180 renal care units and 53 cancer centers, with public facilities like KNH and MTRH leading specialized care.

Benefits of Public Facilities in SHA

Public facilities enhance SHA’s UHC goals by:

• Wide Reach: Over 8,000 facilities serve 80% of Kenyans, particularly in rural areas (70% of population), with 70% of beneficiaries low-income.
• Affordability: Free PHCF services and subsidized SHIF/ECCF care (e.g., KSh 10,650/dialysis session) reduce out-of-pocket costs by 40%.
• Comprehensive Services: From screenings (95% under-5 vaccination coverage) to transplants (KSh 700,000 under ECCF), public facilities cover all SHA benefits.
• Digital Integration: Afya Yangu and *147# USSD streamline claims (80% electronic by mid-2025) and patient access, reducing NHIF’s 90+ day delays.
• Equity: Subsidies for 1.5 million indigent households (September 2025) ensure access for vulnerable urban and rural populations.

By July 2025, public facilities handled 4.5 million primary care visits and 2.2 million specialized services, per SHA reports.

Challenges in Integration

Public facilities face hurdles in SHA integration:

• Reimbursement Delays: KSh 43 billion in unpaid dues (including KSh 33 billion NHIF arrears) by August 2025 disrupt operations, with public hospitals like KNH facing cash flow issues.
• Infrastructure Gaps: Rural Level 1-3 facilities lack equipment (e.g., only 200 prosthetists nationwide), limiting specialized care.
• Overcrowding: Urban hospitals like KNH face 1–2 week wait times due to high patient volumes (1.5 million annually).
• Staff Shortages: Only 500 surgeons serve 54 million, with rural facilities most affected.
• Digital Barriers: Limited internet in ASAL regions hinders Afya Yangu claims submission, causing denials (20% of claims in Q1 2025).

The Rural and Urban Private Hospitals Association (RUPHA) and Kenya Medical Practitioners and Dentists Union (KMPDU) have called for clearing arrears and increasing tariffs (e.g., ICU KSh 28,000/day vs. market KSh 50,000).

Recent Developments

• Disbursements: SHA paid KSh 551 billion by July 2025, with KSh 70 million to KNH in August 2025, though arrears persist.
• BPTAP Oversight: Inaugurated in May 2025, the panel revised tariffs in February 2025 (Legal Notice 56), e.g., hemodiafiltration to KSh 11,200/session.
• Digital Enhancements: Afya Yangu upgrades ensure 80% electronic claims, with 72-hour rejection notices.
• Fraud Crackdown: SHA suspended non-compliant facilities after KSh 20 million ghost claims in 2025.
• Subsidies: Government payment for 1.5 million indigent households started September 2025, boosting public facility access.

Future Outlook

SHA aims to:

• Clear KSh 43 billion arrears by 2026, with PHCF funding to KSh 15 billion and ECCF to KSh 8 billion by 2026/27.
• Train 500 specialists and equip 500 rural facilities by 2027.
• Implement AI-driven diagnostics via Afya Yangu for urban and rural public hospitals.
• Achieve 100% facility integration by 2027, ensuring seamless claims.

Conclusion

Public facilities, from KNH to rural dispensaries, are central to SHA’s UHC mission, serving 26 million Kenyans with affordable, comprehensive care. Integration via accreditation and digital platforms has driven 4.5 million primary care visits and reduced costs by 40%. Challenges like arrears and staffing shortages persist, but reforms signal progress. Patients should verify facility accreditation on sha.go.ke or *147# to access benefits, ensuring public facilities advance Kenya’s health equity goals by 2030.

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