The future of Kenya’s Social Health Authority (SHA) and its flagship Social Health Insurance Fund (SHIF) is under intense scrutiny after a Senate report revealed that only a fraction of registered members are actively contributing to the fund. According to the report, while 18 million Kenyans have signed up for SHA, merely four million are making regular contributions, sparking fears that the ambitious universal health coverage programme could falter under financial strain.
Lawmakers have expressed serious doubts about the viability of sustaining the health insurance scheme with such a significant gap between registration and actual contribution. Endebess MP Robert Pukose voiced strong reservations, describing the situation as a looming disaster. He warned that with such low participation in funding the programme, the viability of SHA is at stake and called for urgent measures to boost compliance and ensure that contributions match enrolment.
One of the core issues is the programme’s overdependence on formal sector workers, who are easily tracked and compelled to contribute. In contrast, the informal sector, which forms a large portion of Kenya’s economy, has proved difficult to regulate. Many individuals in this sector only contribute when in need of healthcare services and stop paying after receiving treatment, undermining the financial stability of the fund. Efforts by the government to enforce mandatory contributions by restricting access to public services for non-compliant individuals were thwarted by the courts, leaving enforcement largely voluntary and ineffective.
The Senate report also raised red flags about the SHA’s failure to adequately plan for coverage of emergency, chronic, and critical illnesses, which are central to achieving universal health coverage. Additionally, the report highlighted systemic challenges such as delays in claim processing and accumulation of pending bills due to system failures, further eroding public confidence in the programme.
Despite SHA’s projection of raising Sh78.9 billion from contributions, healthcare stakeholders remain unconvinced that the fund will remain solvent. Erick Musau, chairperson of the Kenya Association of Private Hospitals, warned that without robust safeguards and improved compliance, the fund could collapse within a year. He urged lawmakers to prioritize measures that would ensure steady and sustainable contributions to prevent the programme’s failure.
In response to the Senate’s concerns, Health Cabinet Secretary Deborah Barasa, Medical Services Principal Secretary Harry Kimtai, Public Health Principal Secretary Mary Muthoni, and SHA CEO Robert Ingasira appeared before the Senate to account for the programme’s progress. Senators questioned the officials about the disparity between the number of registered individuals and actual contributors. Kisii Senator Richard Onyonka was particularly critical, pressing for clarity on the actual number of people expected to pay.
Ingasira defended SHA’s figures, explaining that not all the 20.5 million registered individuals are required to contribute, as the number includes dependants and indigent persons whose premiums are covered by the government. He also disclosed plans to target school-going children in the next phase of registration to broaden the coverage.
However, lawmakers criticized the SHA leadership for lack of visibility and public engagement. Onyonka questioned Ingasira’s communication strategy, suggesting that even senators are unclear about SHA’s activities, let alone the general public. Further, concerns were raised about SHA’s independence, with some senators questioning whether the authority is truly autonomous or under the control of the Ministry of Health.
In defense, PS Kimtai clarified that SHA operates as a delegated function under the Ministry of Health, as stipulated in the SHIF Act, and carries out its mandate as a state agency. Nonetheless, the Senate called for clearer demarcation of roles and more transparent communication to foster public trust and ensure the long-term success of the health insurance programme.
