The introduction of the Social Health Authority (SHA) has transformed healthcare access for many Kenyans, offering relief to patients battling chronic and life-threatening conditions. Yet, while many hail the scheme as a lifeline, the requirement for upfront annual payments remains a stumbling block, particularly for the elderly, unemployed, and low-income families.
For patients with cancer, kidney disease, and heart conditions, SHA has made treatment possible without the crushing burden of out-of-pocket costs. Dialysis sessions, cancer injections, and long-term hospital stays that once forced families to sell land or livestock are now covered. Even when drugs are out of stock in public hospitals, patients can access them in government-approved private facilities through SHA. This has boosted confidence in the system, with many reporting that they no longer face the financial strain previously associated with treatment.
However, the upfront contribution required to activate SHA benefits has emerged as a significant challenge. Families are expected to pay the full year’s premium at once, with contributions ranging from Sh3,600 to Sh6,000 depending on income assessments. While this is lower than what was charged under the now-defunct National Hospital Insurance Fund (NHIF), the one-off payment makes it difficult for unemployed or low-income households to enrol. Many argue that a monthly or quarterly payment option would improve accessibility.
Despite these challenges, health facilities report a dramatic increase in patients benefiting from SHA. At major referral hospitals, nearly 80 percent of inpatients and mothers delivering babies are covered by the scheme. Hospitals are also receiving larger reimbursements compared to NHIF, with increased rates for services such as CT scans, dialysis, and surgical procedures. This has allowed facilities to expand services and maintain operations with greater financial stability.
SHA is also designed to work across all levels of healthcare, from local dispensaries to referral hospitals. Outpatient services at lower-level facilities are free under the Primary Healthcare Fund, which is fully funded by the government. Higher-level hospitals, meanwhile, cater to specialised treatments, supported by the Social Health Insurance Fund (SHIF) and the Emergency, Critical and Chronic Illness Fund.
While teething problems such as delays in claim reimbursements and limited awareness about accessing care at lower levels persist, SHA is seen as a major step towards achieving Universal Health Coverage (UHC). Patients and health professionals alike acknowledge its progress but call for adjustments especially in easing payment structures, improving last-expense support, and strengthening ambulance services.
For now, SHA stands as both a beacon of hope and a system in transition, bridging gaps in healthcare access while leaving room for much-needed reform.
