SHA Medical Cover: A Comprehensive Guide for New Users

Introduction

The Social Health Authority (SHA), launched on October 1, 2024, under the Social Health Insurance Act of 2023, has transformed Kenya’s healthcare landscape by replacing the National Health Insurance Fund (NHIF). Designed to advance Universal Health Coverage (UHC), SHA aims to ensure all 53 million Kenyans access quality healthcare without financial hardship. As of September 2025, SHA has registered over 26.7 million members, disbursed KSh 8 billion to primary care, and treated 4.5 million individuals at no out-of-pocket cost. This guide provides new users with a detailed, factual overview of SHA’s medical cover, including registration, contributions, benefits, access, and practical tips, grounded in Kenya’s current medical situation and supported by government reports, surveys, and public sentiment.

Understanding SHA and Its Structure

SHA consolidates healthcare financing into three funds to address NHIF’s shortcomings, which included low coverage (17% of the population) and mismanagement scandals:

• Primary Health Care Fund (PHCF): Covers free services at community and primary facilities (levels 1–4), funded by taxes and donor support.
• Social Health Insurance Fund (SHIF): Covers hospital-based care (levels 4–6), including inpatient and specialized services, funded by member contributions.
• Emergency, Chronic, and Critical Illness Fund (ECCIF): Supports high-cost treatments like dialysis and cancer care, fully government-funded for registered members.

SHA mandates registration for all Kenyan residents, with contributions tiered by income to ensure equity. By September 2025, 50% of the population is enrolled, with 4.4 million active contributors and 3.3 million means-tested for subsidies. This guide outlines how new users can navigate this system effectively.

Who Is Eligible?

All Kenyan residents, including citizens, refugees, and legal residents, must register with SHA. This includes:

• Formal sector employees (salaried).
• Informal sector workers (e.g., farmers, traders).
• Indigent households, fully subsidized via government programs.
• Children under 18, covered under parents’ or guardians’ accounts.

Non-residents accessing healthcare in Kenya may also register under specific conditions, as outlined by SHA regulations. Unlike NHIF, which struggled with voluntary uptake (only 900,000 informal sector members), SHA’s mandatory model aims for 100% coverage by 2030.

How to Register for SHA

Registration is user-friendly, leveraging digital and physical channels:

1. Online/USSD:

• Dial *147# on any mobile network (Safaricom, Airtel, etc.) and follow prompts to enter your ID number and personal details.
• Alternatively, use the SHA website (www.sha.go.ke) or the Practice 360 mobile app, linked to e-Citizen.
• Requirements: National ID, passport, or alien/refugee ID; phone number; and, for dependents, birth certificates or legal guardianship documents.

1. Physical Centers:

• Visit Huduma Centres, SHA offices, or local chiefs’ offices for biometric registration.
• Community Health Promoters (CHPs, 107,000 deployed) assist in rural areas.

1. Biometric Verification:

• Post-registration, biometrics (fingerprints) are captured to prevent fraud, mandatory for accessing benefits.

As of September 2025, 26.7 million are registered, with 50,000 daily new enrollments. However, only 60% of GeoPoll survey respondents (February 2025, n=961) completed registration, citing technical glitches (10%) and cost fears (25%). New users should verify registration status via *147# or the SHA portal to ensure activation.

Contribution Requirements

SHA contributions are income-based, ensuring affordability:

• Salaried Employees: 2.75% of gross monthly salary, deducted automatically via Kenya Revenue Authority (KRA) integration. Example: KSh 50,000 salary = KSh 1,375/month.
• Informal Sector/Non-Salaried: Minimum KSh 300/month for households earning below KSh 12,000 annually, adjustable via means-testing.
• Indigent Households: Fully subsidized (1.5 million enrolled), funded by CDF and social protection programs.
• Dependents: Spouses, children under 18, and up to four additional dependents (e.g., elderly parents) covered under one contribution.

The “Lipa SHA Pole Pole” program allows installments for low-income earners. By September 2025, SHA collects KSh 45–70 billion annually but faces a KSh 4 billion monthly deficit due to low informal sector uptake (900,000 of 16.7 million). New users should confirm contribution status via *147# to avoid service denials.

Benefits and Coverage

SHA offers comprehensive benefits, significantly expanded from NHIF:

• Primary Care (PHCF): Free consultations, diagnostics, and drugs at levels 1–4 facilities (dispensaries, health centers). Over 1 million visits covered since October 2024.
• Hospital Care (SHIF): Inpatient services, surgeries, and maternity care at levels 4–6 (county and referral hospitals). Covers up to KSh 28,000/day for critical care (vs. NHIF’s KSh 4,480).
• Specialized Care (ECCIF): Oncology (KSh 550,000/year), dialysis, and emergency treatments, fully funded for registered members.
• Preventive Services: Vaccinations, antenatal care, and community health screenings via 100,000 CHP kits.
• Rehabilitative and Palliative Care: Expanded for chronic conditions like diabetes and hypertension.

A 2025 Ministry of Health report notes 4.5 million treatments without OOPE, with 500,000 monthly users accessing critical care. However, X posts highlight rejections at some hospitals due to unpaid NHIF debts, urging users to verify facility contracting status.

Accessing SHA Services

To use SHA benefits:

1. Confirm Registration: Check status via *147# or SHA portal.
2. Select Facility: Visit an SHA-contracted facility (8,813 of 17,755 facilities, 56% coverage). Check the SHA website or app for a list.
3. Present ID: Use your National ID or SHA-issued biometric card for verification.
4. Biometric Approval: Required for inpatient and specialized services to curb fraud.
5. Emergency Access: Court rulings mandate emergency care regardless of contribution status.

Key stats: 89% of contracted facilities are accessible, but rural areas (e.g., Turkana, 40% coverage) lag. GeoPoll found 22% of users mistakenly expect “free” care, so new users should clarify covered services at facilities.

Challenges for New Users

Despite progress, hurdles persist:

• Funding Gaps: Monthly claims (KSh 9.7 billion) exceed collections (KSh 6 billion), risking service interruptions.
• Facility Readiness: Only 56% of facilities are e-contracted, with delays in faith-based hospitals. Rupha rates SHA performance at 44%.
• Public Mistrust: X sentiment (70% negative) cites NHIF scandals and a KSh 104.8 billion project ownership controversy.
• Technical Issues: 10% of GeoPoll respondents faced USSD/app glitches.
• Informal Sector Uptake: Only 5.4% of 16.7 million informal workers contribute, threatening sustainability.

New users should report issues via SHA’s toll-free line (0800-720-531) or X (@SHACareKe).

Practical Tips for New Users

1. Register Early: Complete biometric verification to avoid delays; use CHPs in rural areas.
2. Understand Contributions: Check income-based rates via *147#; apply for subsidies if indigent.
3. Verify Facilities: Confirm SHA contracting before seeking care, especially for specialized services.
4. Monitor Payments: Ensure contributions are up-to-date to avoid claim denials.
5. Engage Support: Use SHA’s 24/7 call center or Huduma Centres for assistance.
6. Stay Informed: Follow SHA updates on X (@SHACareKe) or www.sha.go.ke for policy changes.

Public Perceptions and Expectations

GeoPoll’s 2025 survey reveals 95% awareness but only 13% expect service improvements, with 22% misinterpreting SHA as “free.” X posts praise inclusivity (e.g., “#SHAWorks for maternal care”) but criticize delays and fraud fears. Health CS Aden Duale’s August 2025 statement emphasizes SHA’s role in “touching lives daily,” yet public trust hinges on addressing facility and funding gaps.

Future Outlook

SHA’s trajectory toward UHC 2030 is promising, with 50% coverage achieved in one year. Scaling informal sector contributions (target: 10 million by 2027) and clearing NHIF debts (KSh 30.9 billion) are critical. Digital tools like e-GPS and KRA integration could boost collections to KSh 54 billion annually, while 50,000 more CHPs are planned to enhance access. New users can expect expanded benefits, such as mental health coverage by 2026, if funding stabilizes.

Conclusion

SHA’s medical cover offers new users a gateway to affordable, quality healthcare, with 26.7 million enrolled and KSh 8 billion disbursed to primary care. By understanding registration, contributions, and benefits, users can navigate this system to access free primary care, hospital services, and critical treatments. Challenges like funding deficits and facility readiness require vigilance, but SHA’s digital infrastructure and community outreach lay a strong foundation. As Kenya marches toward UHC by 2030, new users are pivotal to realizing a healthier nation—register, contribute, and engage to ensure SHA delivers on its promise of care without compromise.

KINA MAISHA MAGIC EAST TUESDAY 23RD SEPTEMBER 2025 SEASON 5 EPISODE 101