How SHA Addresses Non-Communicable Diseases in Kenya

Introduction

Non-communicable diseases (NCDs) such as diabetes, hypertension, cancer, and cardiovascular diseases are a growing public health challenge in Kenya, accounting for 39% of deaths and 50% of hospital admissions, according to the Kenya STEPwise Survey for NCD Risk Factors (2015–2022). With a population of 53 million, Kenya faces a rising NCD burden, exacerbated by limited access to care and high out-of-pocket expenses (40% of health spending pre-2024). The Social Health Authority (SHA), launched on October 1, 2024, under the Social Health Insurance Act of 2023, replaces the National Health Insurance Fund (NHIF) to advance Universal Health Coverage (UHC) by 2030. SHA’s targeted approach to NCDs through its Emergency, Chronic, and Critical Illness Fund (ECCIF) and other mechanisms offers hope for millions. By September 2025, SHA has registered 26.7 million Kenyans, treated 4.5 million without out-of-pocket costs, and enhanced NCD care for 500,000 monthly users. This article explores how SHA addresses NCDs, detailing its strategies, benefits, challenges, and future outlook, grounded in Kenya’s medical situation, government reports, surveys, and public sentiment on X.

The NCD Burden in Kenya

NCDs pose a significant threat to Kenya’s health system:

• Prevalence: KDHS 2022 reports 24% of adults have hypertension, 9% have diabetes, and cancer cases rose to 42,000 annually (Globocan 2020). Cardiovascular diseases cause 13% of deaths.
• Economic Impact: NCDs cost households KSh 60 billion annually in out-of-pocket spending, pushing 1 million into poverty yearly (World Bank, 2022).
• Access Gaps: Under NHIF, only 17% of Kenyans had coverage, with rural areas (25% uninsured) and informal sector workers (83% of workforce) hardest hit.
• Risk Factors: STEPwise 2022 notes 24% tobacco use, 27% obesity, and low physical activity, driving NCD incidence.

SHA’s mandate is to reduce these burdens by ensuring equitable, affordable NCD care, particularly through ECCIF, which fully funds high-cost treatments for registered members.

SHA’s Framework for NCD Management

SHA consolidates healthcare financing into three funds, with NCDs primarily addressed via:

• Primary Health Care Fund (PHCF): Funds free preventive and screening services at levels 1–4 (community units, dispensaries, health centers).
• Social Health Insurance Fund (SHIF): Covers outpatient and inpatient NCD management at levels 4–6 (county and referral hospitals).
• Emergency, Chronic, and Critical Illness Fund (ECCIF): Fully funds high-cost NCD treatments like oncology and dialysis, a significant leap from NHIF’s limited coverage.

SHA’s mandatory registration (26.7 million enrolled by September 2025) and tiered contributions (KSh 300/month for indigent to 2.75% of salary) aim to pool resources for sustainability. Digital tools, including biometric verification and the Practice 360 app, streamline access and curb fraud.

Specific SHA Interventions for NCDs

1. Preventive and Screening Services (PHCF)

SHA prioritizes NCD prevention through:

• Community Health Promoters (CHPs): 107,000 CHPs distribute 100,000 health kits, conducting door-to-door screenings for hypertension, diabetes, and cancer risk factors. Over 1 million screenings completed since October 2024.
• Free Primary Care: Level 1–4 facilities offer free diagnostics (e.g., blood pressure, glucose tests) and health education, critical as 50% of NCD cases are undiagnosed (STEPwise 2022).
• Vaccinations and Lifestyle Programs: HPV vaccines for cervical cancer prevention and community campaigns targeting obesity and smoking.

GeoPoll’s February 2025 survey (n=961) notes 95% awareness of SHA but only 34% understand its preventive scope, indicating communication gaps.

2. Outpatient and Inpatient NCD Care (SHIF)

SHIF covers:

• Outpatient Services: Consultations, medications, and diagnostics for hypertension, diabetes, and asthma at 8,813 contracted facilities (56% of 17,755).
• Inpatient Care: Hospitalizations for NCD complications (e.g., stroke, heart failure), with daily coverage up to KSh 28,000 (vs. NHIF’s KSh 4,480).
• Rehabilitative Care: Physiotherapy and counseling for NCD-related disabilities, addressing 24% of adults with chronic conditions (KDHS 2022).

A 2025 Ministry report confirms 4.5 million treatments without out-of-pocket costs, with 1 million outpatient visits for NCDs.

3. High-Cost NCD Treatments (ECCIF)

ECCIF is a game-changer for costly NCDs:

• Oncology: Covers KSh 550,000/year for chemotherapy, radiotherapy, and surgeries, benefiting 42,000 cancer patients annually.
• Dialysis: Fully funded for 10,000+ renal failure patients, up from NHIF’s partial coverage.
• Cardiac Care: Supports surgeries and interventions for cardiovascular diseases (13% of deaths).
• Other Chronic Conditions: Includes treatments for sickle cell anemia and severe asthma.

By September 2025, 500,000 monthly users access ECCIF, with X posts praising “#SHAWorks for cancer care” but noting delays in rural access.

4. Digital and Financial Innovations

• Biometric Verification: Ensures fraud-free access to NCD treatments, rejecting KSh 10.7 billion in false claims.
• Direct Payments: SHA disburses KSh 8 billion to facilities, bypassing county treasuries to reduce delays (unlike NHIF’s KSh 30.9 billion debt).
• Subsidies: 1.5 million indigent households receive free NCD care, with 3.3 million means-tested for subsidies.

Impact on NCD Management

SHA’s interventions have yielded measurable outcomes:

• Access Expansion: 4.5 million treatments without out-of-pocket costs, reducing financial hardship for NCD patients.
• Coverage Growth: 26.7 million registered (50% of population), with 500,000 monthly NCD users, compared to NHIF’s 17% coverage.
• Preventive Reach: Over 1 million screenings via CHPs, detecting 20% more hypertension cases early (Ministry of Health, 2025).
• Equity Gains: 35% of registrants are women, prioritizing maternal and NCD-related care (e.g., breast cancer screening).

A 2025 Cytonn Investments review notes SHA’s potential to save 60% of NCD-related costs if scaled, but only 13% of GeoPoll respondents expect service improvements, reflecting skepticism.

Challenges in Addressing NCDs

Despite progress, SHA faces hurdles:

• Funding Shortfalls: Monthly claims (KSh 9.7 billion) exceed collections (KSh 6 billion), with only 900,000 of 16.7 million informal workers contributing, threatening ECCIF sustainability.
• Facility Readiness: Only 56% of facilities (8,813) are contracted, with rural areas (e.g., Garissa, 40%) underserved. Rupha rates SHA at 44% performance.
• Awareness Gaps: GeoPoll’s survey shows 22% misconceive SHA as “free,” and only 34% understand NCD benefits, especially in rural areas (45% of sample).
• Public Trust: X sentiment (70% negative) cites NHIF scandals and a KSh 104.8 billion project ownership controversy, with users like @C_NyaKundiH labeling SHA a “scam.”
• Human Resources: Doctor-patient ratio (1:5,000) and drug shortages limit NCD care delivery (IEA, 2025).

Practical Guidance for NCD Patients

For Kenyans with NCDs:

1. Register Promptly: Use *147#, www.sha.go.ke, or CHPs to enroll; include dependents for family coverage.
2. Undergo Means-Testing: Apply for subsidies if low-income; 3.3 million already qualify.
3. Access Screenings: Visit level 1–4 facilities or CHPs for free hypertension, diabetes, and cancer checks.
4. Verify Facilities: Check SHA’s website for contracted hospitals, especially for oncology/dialysis.
5. Monitor Contributions: Ensure payments (KSh 300–1,375/month) via M-Pesa (Paybill 222111) to access ECCIF.
6. Report Issues: Use SHA’s toll-free line (0800-720-531) or X (@SHACareKe) for support.

Future Outlook for NCD Management

SHA aims for 80% coverage by 2028, requiring 10 million informal sector contributors to close the KSh 4 billion funding gap. Planned initiatives include:

• KRA-SHA Integration: Auto-deductions to boost collections to KSh 54 billion annually.
• Infrastructure Investment: A KSh 194 billion UAE loan for NCD-specialized facilities.
• Workforce Expansion: 50,000 additional CHPs by 2026 to enhance screenings.
• New Benefits: Mental health coverage by 2026, addressing NCD comorbidities.

WHO projects that scaling primary care could prevent 60 million NCD deaths regionally by 2030. Kenya’s CHU4UHC platform aims to digitize NCD tracking by 2027, improving outcomes. CS Aden Duale’s August 2025 statement underscores SHA’s role in “saving lives daily,” but trust-building via transparent audits is critical.

Conclusion

SHA’s multifaceted approach to NCDs—prevention via PHCF, treatment through SHIF, and high-cost care under ECCIF—marks a significant advance over NHIF, delivering 4.5 million treatments without out-of-pocket costs and screening millions for early detection. With 500,000 monthly NCD users and KSh 550,000 oncology coverage, SHA alleviates the financial and health burdens of diseases like cancer and diabetes. However, funding deficits, low informal sector uptake, and rural access gaps threaten sustainability. By registering, contributing, and leveraging CHPs, Kenyans can maximize SHA’s benefits, ensuring NCD care becomes a cornerstone of UHC by 2030, transforming lives and securing a healthier future.

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