SHA’s Approach to Epidemic Preparedness

Introduction

Kenya’s healthcare system has been tested by recurrent epidemics, from the 2018 cholera outbreak affecting 5,000 cases to the COVID-19 pandemic that claimed over 5,000 lives and exposed surveillance gaps. With a population of 53 million and vulnerabilities like flooding, urbanization, and climate change driving outbreaks, epidemic preparedness is paramount. The Social Health Authority (SHA), established under the Social Health Insurance Act of 2023 and operational since October 1, 2024, replaces the National Health Insurance Fund (NHIF) to advance Universal Health Coverage (UHC) by 2030. SHA’s model—pooling resources into the Primary Health Care Fund (PHCF), Social Health Insurance Fund (SHIF), and Emergency, Chronic, and Critical Illness Fund (ECCIF)—integrates financial protection with public health resilience. By September 2025, SHA has registered 26.7 million members and disbursed KSh 8 billion to frontline services, positioning it to support epidemic responses amid ongoing threats like the 2025 cholera outbreak in four counties and chikungunya surges. This article examines SHA’s approach to epidemic preparedness, drawing on Kenya’s medical context, Ministry of Health (MoH) reports, WHO updates, and recent initiatives.

Kenya’s Epidemiological Challenges

Kenya faces a dual burden of communicable diseases and emerging threats:

• Historical Outbreaks: Cholera recurs biennially, with 2025 cases exceeding 2,000 in Nairobi, Kisumu, Migori, and Kwale due to heavy rains (WHO, March 2025). Mpox (Clade Ib) emerged in July 2024, with 1,200 cases by February 2025 (CDC, 2025). Chikungunya, mosquito-borne, saw over 7,000 cases regionally by July 2025, including Kenya (LSHTM, August 2025).
• Risk Factors: Climate events (e.g., El Niño floods) displace 200,000 annually, while urbanization in slums like Kibera heightens transmission. The Kenya Demographic and Health Survey (KDHS 2022) notes 83% informal sector workers lack baseline coverage, amplifying vulnerabilities.
• System Gaps: Pre-SHA, NHIF’s 17% coverage and KSh 30.9 billion debt hindered surge capacity. The Joint External Evaluation (JEE) 2023 scored Kenya 52% on International Health Regulations (IHR) core capacities, below the 70% global target.

SHA addresses these by embedding preparedness into UHC, ensuring financial risk protection during outbreaks while strengthening surveillance and response.

SHA’s Integrated Framework for Epidemic Preparedness

SHA’s approach aligns with the WHO’s Health Systems Framework for epidemic readiness, emphasizing prevention, detection, and response (Frontiers in Tropical Diseases, August 2025). It leverages three funds:

• PHCF: Funds community-level surveillance and preventive care at levels 1–4 facilities, covering 85% of essential services.
• SHIF: Supports inpatient surge capacity at levels 4–6, including isolation units.
• ECCIF: Covers high-cost interventions like antivirals and vaccines during epidemics, fully subsidized for vulnerable groups.

Mandatory registration (26.7 million by September 2025) pools KSh 45–70 billion annually, with digital tools (e.g., *147# USSD, Practice 360 app) enabling real-time claims for outbreak responses. SHA collaborates with the newly launched Kenya National Public Health Institute (KNPHI, May 2025), which manages surveillance, port health, and emergency operations transferred from MoH.

Data from MoH and KNPHI reports (2025).

Key Components of SHA’s Epidemic Preparedness Strategy

1. Surveillance and Early Warning Systems

SHA enhances detection through PHCF-funded community networks:

• Community Health Promoters (CHPs): 107,000 CHPs conduct weekly surveillance, reporting via Afya Timiza app. In the 2025 cholera response, CHPs identified 70% of cases early in affected counties (WHO, March 2025).
• Integration with KNPHI: SHA shares claims data for real-time outbreak analytics. KNPHI’s public health emergency operations center (EOC) processes SHA alerts, improving IHR compliance.
• Digital Innovations: Biometric verification flags clusters (e.g., mpox cases), rejecting fraud while tracking trends. The Early Warnings for All (EW4All) initiative, launched May 2025, tailors multi-hazard systems to SHA facilities, ensuring vernacular alerts via SMS (UNDDR, May 2025).

GeoPoll’s February 2025 survey (n=961) shows 95% SHA awareness, but only 40% understand surveillance roles, underscoring education needs.

2. Response Capacity and Surge Funding

During outbreaks, SHA activates rapid financing:

• Facility Contracting: 8,813 facilities (56% of 17,755) are e-contracted, enabling bi-weekly payments (KSh 8 billion disbursed by September 2025). In chikungunya hotspots, SHIF covered 500,000 outpatient visits without out-of-pocket costs.
• Isolation and Treatment: ECCIF funds temporary cholera treatment units (CTUs) in high-risk counties. For mpox, SHA supported 1,000 isolation beds, drawing from NHIF’s lessons.
• Vaccine and Supply Chains: Partnerships with GAVI and WHO ensure free vaccines (e.g., oral cholera vaccine for 1 million doses in 2025). SHA’s e-GPS integration prevents stockouts.

The Bi-Regional Health Emergency Leaders’ Meeting (September 2025) highlighted Kenya’s leadership in cross-border networks, with SHA funding 20% of regional mpox responses (MoH, September 2025).

3. Workforce Training and Community Engagement

SHA invests in human resources:

• Training Programs: Via KNPHI’s Field Epidemiology and Laboratory Training (FELTP), 1,200 health workers were trained in 2025 for outbreak management, including SHA claims processing during surges.
• Community Resilience: PHCF supports the Kenya Community Health Strategy 2020–2025, empowering CHPs to build trust. In Kwale’s cholera outbreak, community-led hygiene campaigns reduced cases by 30% (WHO, 2025).
• Equity Focus: Subsidies cover 1.5 million indigent households, prioritizing pastoralist communities in northern Kenya prone to Rift Valley fever.

The Epidemic Ready Primary Healthcare (ERPHC) pilot (December 2023–October 2024) in Kenya scored facilities 65% on preparedness indicators, up from 45% pre-SHA (BMJ Global Health, September 2025).

4. Financial Protection During Epidemics

SHA shields households from catastrophic costs:

• Zero Out-of-Pocket: 4.5 million treatments covered by September 2025, including 20% outbreak-related. For cholera, ECCIF funds rehydration and antibiotics up to KSh 28,000/day.
• Means-Testing: 3.3 million subsidized, ensuring informal sector (16.7 million workers) access without premiums during crises.
• Sustainability Measures: Despite a KSh 4 billion monthly deficit, SHA’s 4.4 million active contributors fund reserves for emergencies.

Integration with National and Global Initiatives

SHA aligns with broader efforts:

• KNPHI Launch (May 2025): Enhances SHA’s data analytics for predictive modeling (IANPHI, 2025).
• EW4All and EARGHSS 2025: SHA facilities integrate MHEWS; the East Africa Regional Global Health Security Summit (January 2025) roadmap includes SHA for biosecurity (GHSS Africa).
• WHO Support: Cholera training in 120 workers across counties (2024–2025) feeds into SHA’s response protocols.
• Research and Innovation: A 2025 JOGH study on lab systems in Kenya emphasizes SHA’s role in pandemic diagnostics, advocating for domestic funding.

Challenges and Gaps

Despite advances, obstacles remain:

• Funding Shortfalls: Collections (KSh 6 billion/month) lag claims (KSh 9.7 billion), with only 900,000 informal contributors (5.4% uptake).
• Rural Disparities: Northern counties (e.g., Turkana, 40% facility coverage) lag urban areas (70%), per Rupha 2025 ratings (44% overall).
• Workforce Strain: Doctor-patient ratio (1:5,000) overwhelms surges; therapist shortages affect post-outbreak recovery.
• Public Trust: GeoPoll notes 13% optimism; X discourse (limited 2025 posts) echoes NHIF-era skepticism on “looting.”
• Emerging Threats: Mpox and chikungunya highlight zoonotic risks, with JEE gaps in lab capacity (Frontiers, 2025).

Future Outlook and Recommendations

SHA targets 80% coverage by 2028, projecting KSh 54 billion annual collections via KRA integration. Planned steps include:

• UAE Loan (KSh 194 billion): For EOC upgrades and vaccine stockpiles.
• CHP Expansion: 50,000 more by 2026 for surveillance.
• Digital Enhancements: Full DHIS2-SHA linkage by FY2025/26.
• Policy Alignment: Incorporate ERPHC into UHC blueprint, aiming for 70% JEE score by 2030.

Recommendations:

• Accelerate informal enrollment with incentives.
• Invest in rural labs and training (e.g., FELTP scale-up).
• Enhance communication via vernacular media.
• Foster public-private partnerships for supply chains.

Conclusion

SHA’s approach to epidemic preparedness—through surveillance via CHPs, surge funding across funds, and integration with KNPHI—transforms Kenya’s response from reactive to resilient, as seen in the 2025 cholera and mpox management. With 4.5 million protected treatments and early detection via EW4All, SHA mitigates financial ruin amid outbreaks affecting millions. Challenges like funding gaps and rural inequities demand urgent action, but with 26.7 million enrolled, SHA is pivotal to UHC 2030. As CS Aden Duale noted in September 2025, “Preparedness is our shield”—SHA ensures no epidemic catches Kenya unprepared, safeguarding lives and livelihoods in a vulnerable world.

HUBA MAISHA MAGIC BONGO 24TH SEPTEMBER 2025 WEDNESDAY LEO USIKU SEASON 15 EPISODE 83