Kenya’s health system stands at a crossroads. The SHA dream of universal coverage is bold, but its promise will only be fulfilled through transparent, accountable, and people-centered implementation.

Background: A Bold Shift in Kenya’s Healthcare

On October 1, 2024, Kenya officially transitioned from the National Health Insurance Fund (NHIF) to the Social Health Authority (SHA), marking a new chapter in the country’s quest for universal health coverage. The Social Health Insurance Act 2023 created the SHA to oversee a broader, more inclusive health insurance system aiming for 100% enrollment, an ambitious leap from NHIF’s 20% coverage, said Health PS Mary Muthoni.

Objectives: Healing Old Wounds, Expanding Access

The switch promised more than a name change. SHA manages three key funds: Primary Healthcare, Social Health Insurance, and Emergency, Chronic and Critical Illness—each designed to fund care seamlessly across all counties. The goal? Make health care affordable, accessible, and transparent, especially for everyday Kenyans often sidelined under the old system.

Challenges: Ghosts of Fraud and Financial Fallout

Yet shadows loom. Auditor-General Nancy Gathungu’s damning 2023 report revealed NHIF fraud on a massive scale—duplicate claims, inflated billing, and ghost beneficiaries syphoning billions. These abuses forced NHIF’s closure, leaving a heavy debt load of KSh 25 billion unpaid premiums that stalled payments to hospitals.

Under SHA, hopes ran high for reform. But controversies persist: 40 health facilities faced suspension in 2025 over fraudulent SHA claims like upcoding and fake patients. Private hospitals have paused SHA services, frustrated by reimbursement delays and unresolved NHIF debts.

On the Ground: What Kenyans Experience

The gap between policy and practice hits hardest in rural and underserved areas. Reports surface of clinics turning away NHIF cardholders or asking for cash despite coverage. Infrastructure shortages and staff gaps make insurance promising, but not always delivering.

One patient shared on social media, “I queued for hours, only to be told tests aren’t covered. What’s the point of insurance then?” Such stories threaten public confidence.

What Lies Ahead?

The transition is a work in progress. Successful realization depends on:

• Rooting out fraud and abuse decisively

• Clearing arrears and timely provider payments

• Strengthening public communication and education

• Investing in healthcare infrastructure and staffing

Without these steps, coverage may remain just insurance on paper, while many Kenyans continue to bear healthcare costs out of pocket.