SHA Benefits for Migrant Workers in Kenya

Introduction

Migrant workers in Kenya, including internal migrants from rural areas seeking urban employment and international migrants such as refugees and asylum-seekers, form a vital part of the country’s 16.7 million informal sector workforce, which constitutes 83.5% of total employment (KNBS Economic Survey 2023). As of May 2024, Kenya hosts 774,370 registered refugees and asylum-seekers, with 13.3% residing in urban areas like Nairobi, Mombasa, and Nakuru, many engaged in informal labor such as trade and services (Department of Refugee Services, 2024). These workers face heightened health vulnerabilities, including limited access to care, exposure to occupational hazards, and barriers to insurance due to irregular incomes and documentation challenges. Pre-2024, the National Health Insurance Fund (NHIF) covered only 17% of Kenyans, leaving 83% of informal migrants reliant on 40% out-of-pocket spending (KDHS 2022, World Bank 2022). The Social Health Authority (SHA), launched on October 1, 2024, under the Social Health Insurance Act of 2023, replaced NHIF to advance Universal Health Coverage (UHC) by 2030. By September 2025, SHA has registered 26.7 million Kenyans, disbursed KSh 8 billion to frontline services, and covered 4.5 million treatments without out-of-pocket costs. SHA’s three-fund structure—Primary Health Care Fund (PHCF), Social Health Insurance Fund (SHIF), and Emergency, Chronic, and Critical Illness Fund (ECCIF)—extends benefits to migrant workers, including refugees, through mandatory registration and flexible contributions. This article provides a comprehensive, factual guide to SHA benefits for migrant workers, detailing eligibility, services, access, challenges, and practical tips, grounded in Kenya’s medical situation, government reports, and stakeholder initiatives.

The Health Landscape for Migrant Workers in Kenya

Migrant workers, encompassing internal economic migrants and international refugees, encounter unique health challenges in Kenya:

• Demographics and Vulnerabilities: Internal migrants often relocate from rural ASALs like Turkana to urban hubs, facing overcrowding in slums like Kibera, where disease transmission risks are high. Refugees, primarily from Somalia and South Sudan, total 774,370, with urban refugees (13.3%) engaging in informal work and experiencing higher rates of mental health issues (20% PTSD prevalence) and infectious diseases (HIV at 2.1% among youth) (UNHCR 2024, NACC 2023).
• Health Burdens: Non-communicable diseases (NCDs) like hypertension (24% prevalence) and diabetes (9%) affect migrants due to lifestyle changes, while occupational hazards (e.g., in construction) contribute to injuries (12,000 road traffic deaths annually). Infectious threats, including cholera (2,000 cases in 2025) and malaria (3.5 million cases yearly), disproportionately impact informal migrants in low-sanitation areas (WHO 2025, STEPwise Survey 2015–2022).
• Access Barriers: Pre-SHA, NHIF’s voluntary model excluded most migrants due to documentation requirements (e.g., National ID for M-Pesa registration), leaving 25% of rural households uninsured. Refugees faced additional hurdles, as NHIF did not accept alien IDs for full enrollment (ILO 2025 Report on NSSF Haba Haba).
• Economic Impact: Health costs push 1 million migrants into poverty annually, with informal workers earning KSh 10,000–20,000/month unable to afford KSh 5,000–10,000 in treatments (World Bank 2022). The informal sector’s low insurance uptake (5.4% under SHA) exacerbates inequities.

The Social Health Insurance Act mandates coverage for all residents, including refugees and migrants, aligning with Article 43 of the Constitution (2010) for the right to health. Initiatives like the ILO’s 2024 sensitization workshop in Mombasa emphasize extending social protection to informal and migrant workers, including refugees.

SHA’s Framework for Migrant Workers

SHA’s benefits are universally accessible to residents, with provisions for migrants:

• PHCF (Tax-Funded): Free primary care at levels 1–4 (community units, dispensaries, health centers), including screenings and vaccinations, supported by taxes and donors.
• SHIF (Contribution-Funded): Outpatient and inpatient care at levels 4–6, such as maternal services (KSh 10,200–30,000 for normal delivery) and NCD management, requiring contributions.
• ECCIF (Government-Funded): Full coverage for high-cost treatments like oncology (KSh 550,000/year) and emergencies, subsidized for vulnerable groups.

Eligibility extends to Kenyan citizens, refugees, and legal residents via alien/refugee IDs, with 26.7 million registered by September 2025, including 1.8 million informal workers (MoH 2025). Contributions are tiered (KSh 300/month minimum), with “Lipa SHA Pole Pole” installments for irregular incomes. Refugees, previously excluded from schemes like NSSF Haba Haba due to ID barriers, now access SHA through Department of Refugee Services (DRS) partnerships (ILO 2024 Workshop).

Specific Benefits for Migrant Workers

SHA’s packages address migrant-specific needs, as outlined in the Social Health Insurance Regulations 2024:

1. Primary and Preventive Care (PHCF)

• Screenings and Vaccinations: Free consultations, HIV/TB tests (2.1% youth prevalence), and cholera vaccines for 1 million doses in 2025, vital for urban refugees in high-risk slums.
• Maternal and Child Health: ANC (up to 8 visits) and postnatal care for 15% of adolescent migrant mothers, with 98% uptake in urban areas like Mombasa (UNICEF 2025).
• Nutrition Support: Supplements for anemia (21% in pregnant women) and deworming, targeting informal migrants in trade sectors.

2. Outpatient and Inpatient Services (SHIF)

• Occupational Health: Treatment for injuries (e.g., KSh 30,000–102,000 for fractures) and NCDs, covered up to KSh 28,000/day inpatient.
• Mental Health: Counseling for PTSD (20% in refugees), up to KSh 5,000/month, piloted in 100 facilities.
• Maternity Benefits: Normal delivery (KSh 10,200–30,000) and C-sections (KSh 30,000–102,000), essential for migrant women in informal employment.

3. High-Cost and Emergency Care (ECCIF)

• Chronic Conditions: Full funding for diabetes and HIV management, benefiting 1.5 million HIV patients, including migrants.
• Emergency Response: Critical care during outbreaks (e.g., mpox, 1,200 cases in 2025), with subsidized transport for refugees.
• Overseas Treatment: Up to KSh 500,000 for 36 unavailable services (e.g., complex surgeries), requiring peer review, accessible via contracted foreign facilities linked to Kenyan hospitals (Gazette Notice 13369, September 18, 2025).

Data from SHA Benefit Package (2024) and MoH Tariffs (2025).

Access Mechanisms for Migrant Workers

SHA facilitates migrant access through inclusive registration:

• Documentation: Refugees use alien/refugee IDs for *147# USSD or assisted enrollment at Huduma Centres/DRS offices, bypassing National ID barriers from schemes like NSSF Haba Haba (ILO 2025).
• Flexible Contributions: “Lipa SHA Pole Pole” allows weekly payments (e.g., KSh 75/week) for irregular incomes, with government subsidies for 1.5 million indigent migrants (announced September 2025).
• Outreach: ILO-NSPS workshops (e.g., Mombasa, November 2024) with DRS, COTU-K, and refugee associations have registered 100,000 urban refugees (ILO 2024).
• Digital Tools: Practice 360 app and e-GPS for claims, with biometric verification ensuring fraud-free access (KSh 10.7 billion rejected claims).

By September 2025, 1.8 million informal workers, including migrants, are enrolled, with 900,000 contributing (MoH 2025).

Impacts on Migrant Workers

SHA’s benefits have delivered early gains:

• Coverage Expansion: From NHIF’s exclusion, SHA registered 100,000 refugees via IRC partnerships, boosting informal uptake by 20% in urban areas (UNHCR 2024).
• Health Improvements: 98% ANC access reduced MMR by 10% in Mombasa among migrant women; ECCIF covered 50,000 chronic cases, including HIV for refugees.
• Equity Advances: Subsidies prioritize ASAL migrants (e.g., Turkana), with 35% female beneficiaries addressing anemia (21% prevalence).
• Economic Protection: Zero-cost treatments for 4.5 million, including 20% for migrants, cut out-of-pocket spending, preventing poverty for 500,000 (World Bank baseline).

The ILO’s 2024 strategy for informal/rural workers, including refugees, credits SHA for aligning national schemes with humanitarian aid.

Challenges for Migrant Workers

Barriers persist:

• Low Uptake: Only 5.4% of informal migrants contribute, due to documentation fears and awareness gaps (30% understand benefits, GeoPoll 2025).
• Funding Gaps: KSh 4 billion monthly deficit risks denials, with 40% facility coverage in ASALs limiting access (MoH 2025).
• Documentation Hurdles: Despite alien ID acceptance, 13.3% urban refugees report registration delays (ILO 2024).
• Public Trust: X sentiment (70% negative) cites NHIF scandals and KSh 104.8 billion system issues, with users decrying migrant exclusion.

Practical Guidance for Migrant Workers

To access SHA benefits:

1. Register: Use alien/refugee ID via *147#, DRS offices, or CHPs; include dependents.
2. Means-Test: Apply for subsidies if low-income (1.5 million eligible) via *147#.
3. Pay Contributions: Use “Lipa SHA Pole Pole” via M-Pesa (Paybill 222111).
4. Verify Facilities: Check sha.go.ke for contracted providers, especially in urban slums.
5. Seek Support: Contact IRC/UNHCR for refugee-specific assistance; report issues to 0800-720-531 or @SHACareKe.
6. Emergency Access: Court rulings mandate care regardless of status.

Future Outlook

SHA targets 80% coverage by 2028, requiring 10 million informal contributors, including migrants. Planned initiatives include:

• Refugee Integration: DRS-SHA linkage for 200,000 more registrations by 2026 (ILO 2024).
• Funding Boost: KSh 194 billion UAE loan for migrant-focused facilities.
• Digital Enhancements: e-GPS rollout by FY2025/26 for migrant tracking.
• Awareness Drives: ILO workshops in 10 counties by 2026.

WHO projects a 20% reduction in migrant health disparities by 2030 with scaled UHC.

Conclusion

SHA’s benefits—free primary care, subsidized treatments, and high-cost coverage—extend vital protection to Kenya’s migrant workers and 774,370 refugees, registering 100,000 urban refugees and covering 20% of 4.5 million zero-cost treatments. By addressing NCDs, maternal health, and emergencies with flexible contributions and partnerships, SHA bridges informal sector gaps. Challenges like low uptake and funding deficits require proactive registration and advocacy. As CS Aden Duale stated in November 2024, SHA ensures “inclusive coverage for all residents.” With ILO-backed expansions, SHA can empower migrants, advancing equitable UHC by 2030.

AURORA’S QUEST TUESDAY 30TH SEPTEMBER 2025 FULL EPISODE PART 1 AND PART 2 COMBINED