Public Perceptions of SHA: Survey Insights

Introduction

Kenya’s healthcare landscape has undergone a seismic shift with the establishment of the Social Health Authority (SHA) in October 2024, replacing the long-standing National Health Insurance Fund (NHIF). Enacted through the Social Health Insurance Act of 2023, SHA aims to advance Universal Health Coverage (UHC) by pooling resources into three dedicated funds: the Primary Health Care Fund (for levels 2 and 3 facilities), the Social Health Insurance Fund (SHIF, for levels 4-6), and the Emergency, Chronic, and Critical Illness Fund (ECCIF). This reform promises equitable access to quality healthcare without financial hardship, targeting Kenya’s 53 million population, where only about 17% were previously covered by NHIF as of 2023.

As of September 2025, SHA boasts over 25.8 million registered members—a dramatic increase from NHIF’s 7 million—yet public perceptions remain deeply divided. Surveys and social media sentiment reveal a mix of cautious optimism and widespread frustration. A landmark GeoPoll survey conducted in early 2025, involving 961 respondents aged 18 and above (59% aged 25-35, balanced by gender), provides critical insights into awareness, understanding, and attitudes. This article draws on that survey, alongside other data from sources like the Kenya Demographic and Health Survey (KDHS) 2022, policy analyses, and real-time X (formerly Twitter) discussions, to unpack how Kenyans view SHA amid ongoing implementation challenges.

Background: From NHIF to SHA

Kenya’s pursuit of UHC dates back to the 2010 Constitution, which mandates the right to the highest attainable standards of health. NHIF, established in 1966, struggled with low coverage (only 27% of the informal sector insured), mismanagement scandals, and unequal benefits, leaving 83% of Kenyans out-of-pocket for care. SHA addresses these by mandating registration for all residents, with tiered premiums (e.g., KSh 300 monthly for the indigent, up to 2.75% of gross salary for high earners) and tax-funded elements for vulnerable groups.

Implementation began amid fanfare but hit roadblocks: a High Court ruling deemed parts unconstitutional in late 2023 (overturned on appeal in September 2024), inherited NHIF debts of KSh 30.9 billion, and technical glitches in digital registration. By mid-2025, while 19.3 million were registered, only 3.3 million had undergone means-testing for subsidies, and active contributors hovered at 3.3 million—highlighting a funding gap where monthly claims (KSh 9.7 billion) outstrip collections (KSh 6 billion).

Survey Methodology and Demographics

The GeoPoll survey, fielded via mobile phones in February-March 2025, targeted a nationally representative sample across urban and rural Kenya. Respondents were 52% female and 48% male, with urban areas slightly overrepresented (reflecting mobile access). Questions probed awareness (“Have you heard of SHA/SHIF?”), knowledge (“What is SHIF’s purpose?”), registration status, and expectations (“Will SHIF improve services?”). Complementary insights come from KDHS 2022 (pre-SHA baseline on health access) and X semantic searches (January-September 2025), capturing 15 posts on “public perceptions of SHA in Kenya survey insights,” which trended toward skepticism (e.g., 67% dissatisfaction in one informal poll).

These tools reveal a perception gap: high awareness but shallow understanding, exacerbated by poor communication.

Key Findings: Awareness, Understanding, and Registration

Awareness Levels

Awareness of SHA/SHIF stands at an impressive 95%, per GeoPoll—a testament to government campaigns via USSD (*147#), Huduma Centres, and community health promoters. However, only 34% report “extensive knowledge,” with 61% citing basic familiarity from media or word-of-mouth. Rural respondents (45% of sample) lag urban ones by 15%, aligning with KDHS 2022 findings where 25% of rural households lacked health insurance.

X posts echo this: Users like @publicopion highlight “23 million registered,” but complaints dominate, such as @OchungaI’s anecdote of a hospital rejecting SHA coverage despite registration.

Understanding of SHIF’s Purpose

Perceptions of SHIF vary widely, signaling confusion:

This table underscores a core issue: 22% view it as “free,” fueling expectations unmet by premium requirements. A 2025 eHealth literacy study among health students found low eHEALS scores correlated with poor SHA knowledge, predicting only 40% uptake among youth.

Registration and Enrollment

60% of GeoPoll respondents have registered, but 40% cite barriers: 25% fear costs, 15% distrust (citing NHIF scandals), and 10% report technical issues. Informal sector enrollment is dismal—only 900,000 of 16.7 million eligible, down 50% from NHIF. X keyword searches (“SHA Kenya perceptions”) yield 20 recent posts, with 70% negative (e.g., @PropesaTV: “67% dissatisfied—SHA is a scam”).

By September 2025, totals reached 25.8 million, but active payers remain low, per Ministry of Health briefings.

Expectations and Optimism

Only 13% expect SHIF to “improve services,” 5% believe it outperforms NHIF, and 4% prioritize affordability. Optimism peaks among youth (18% in 25-35 bracket) but dips in low-income groups (8%). A Cytonn Investments review notes public hope for “no financial hardship,” yet 2025 Rupha surveys show SHA performance at 44% (down from 46%), graded “D” for delays and exclusions.

X semantic analysis reveals polarized views: Positive posts (30%) praise inclusivity (#DeliveringUHC), while 70% decry “looting” (@C_NyaKundiH: “Criminal enterprise enriching vendors”).

Challenges Shaping Perceptions

Implementation hurdles amplify skepticism:

• Funding Shortfalls: KSh 4 billion monthly deficit; World Bank warns unsustainability without informal sector buy-in.
• Service Delivery: Hospitals reject SHA patients over unpaid NHIF debts; long waits and drug shortages persist. Rupha reports 46% of facilities未 e-contracted by January 2025 due to financial strain.
• Communication Gaps: MPs in January 2025 demanded better outreach; CS Aden Duale urged vernacular radio use.
• Equity Issues: Low-income access barriers contradict “Lipa SHA Pole Pole” installment plan; court rulings mandate emergency care regardless of status.
• Fraud Allegations: Auditor General flagged KSh 104.8 billion SHA project ownership by a private consortium, eroding trust.

KDHS 2022 baseline shows 3.3% healthcare inflation, now worsened; X posts like @Dr_AustinOmondi’s highlight 500,000 monthly users straining resources.

Regional and Demographic Variations

Perceptions vary: Urban youth (Nairobi, 65% registered) are more optimistic (18% expect improvements) than rural elderly (Marsabit, <40% awareness per Kulan Post). Northern Kenya favors SHA over NHIF for remoteness coverage but demands awareness drives. Women (52% sample) emphasize maternal benefits, yet KDHS notes persistent gaps in antenatal care.

Implications for UHC and Policy Recommendations

SHA’s mixed reception risks stalling UHC: High awareness builds momentum, but low trust and uptake could revert to out-of-pocket spending (40% of health expenditure pre-SHA). Positive stories—e.g., a teacher’s wife saved without cost—show potential, but failures like stranded patients abroad undermine gains.

Recommendations from surveys:

• Enhance Communication: Vernacular campaigns and digital literacy (targeting eHEALS gaps).
• Boost Informal Enrollment: Subsidies and incentives; multi-sectoral committees (launched October 2024) for grassroots monitoring.
• Address Funding: Clear NHIF debts; enforce contributions via KRA integration.
• Stakeholder Engagement: Involve providers (e.g., RUPHA) in e-contracting; audit transparency to counter fraud claims.

Conclusion

Public perceptions of SHA, as illuminated by the GeoPoll survey and echoed in X discourse, paint a picture of promise tempered by peril. With 95% awareness but only 13% optimism, Kenya stands at a crossroads: SHA could redefine healthcare as a right, covering 85% of needs at primary levels and easing financial burdens. Yet, without tackling funding gaps, service failures, and mistrust—rooted in NHIF’s legacy—skepticism may harden. As CS Duale noted in August 2025, “It’s just a matter of time,” but time demands action. For UHC to succeed, SHA must evolve from reform to reality, ensuring every Kenyan’s health story ends in hope, not hardship. Ongoing surveys will be vital to track progress toward this equitable future.

HUBA MAISHA MAGIC BONGO 23RD SEPTEMBER 2025 TUESDAY LEO USIKU SEASON 15 EPISODE 82