The Social Health Authority (SHA) has made significant progress in healthcare financing, collecting Sh20.9 billion in contributions and disbursing Sh18.2 billion in claims since October 2024. According to the Ministry of Health, this disbursement plays a crucial role in ensuring that healthcare providers receive timely reimbursements, preventing disruptions in service delivery.
The Ministry outlined that of the total Sh18.2 billion paid in claims, Sh16.97 billion went toward Social Health Insurance Fund (SHIF) claims, while Sh1.33 billion was allocated to Primary Health Care capitation. This distribution highlights the government’s commitment to supporting both inpatient and outpatient healthcare services under its Universal Health Coverage (UHC) initiative, Taifa Care.
By ensuring payments to both public and private health facilities, the government aims to safeguard uninterrupted healthcare access for all Kenyans. The SHA has adopted a more structured financing model that accommodates different income levels, ensuring that healthcare remains accessible to the most vulnerable.
One of the key reforms under SHA is the reduction of the minimum contribution for the most vulnerable households. Previously set at Sh500 under the National Health Insurance Fund (NHIF), the amount has now been lowered to Sh300. This revision is designed to ease the financial burden on low-income earners, making it more feasible for them to access quality healthcare.
The contribution structure is progressive, meaning households and employees in the formal sector contribute varying amounts based on their income levels. This system prevents low-income Kenyans from being excluded from healthcare coverage due to financial constraints while ensuring those with higher earnings contribute more to sustain the fund.
The Ministry emphasized its commitment to transparency and efficiency in handling SHIF payments nationwide. To achieve this, SHA has prioritized faster claim processing through digital platforms that enable real-time tracking and streamlined verification.
Despite a legally prescribed 90-day credit period for claim settlement, SHA has significantly reduced processing time, disbursing payments within 30 days. This proactive approach strengthens healthcare financing, reduces financial strain on hospitals, and enhances the overall responsiveness of the health system.
However, some claims remain pending due to incomplete documentation, ongoing verification, or preauthorization challenges. The Ministry assured that it is working closely with healthcare facilities to accelerate claim processing and resolve any outstanding issues.
“Hospitals facing delays are encouraged to engage with SHA for assistance in addressing submission issues and improving claim accuracy,” the Ministry stated.
To ensure financial integrity within the sector, all claims undergo a clinical audit before payments are processed. This verification process confirms that preauthorized procedures were appropriately approved and performed.
“This rigorous verification ensures that healthcare funds are disbursed appropriately, preventing fraud and improving financial integrity within the sector,” the Ministry affirmed.
By implementing these measures, SHA is reinforcing the government’s commitment to achieving Universal Health Coverage, strengthening the financial sustainability of healthcare facilities, and improving service delivery across Kenya.
