Over 31mn Kenyans Registered Under SHA As Govt Moves to Clear NHIF Debts

Kenya's Social Health Authority (SHA) has registered over 31.2 million Kenyans, marking a significant expansion in health insurance coverage under the government's Universal Health Coverage (UHC) programme. This development follows the operationalisation of the Social Health Insurance Act, 2023 (SHIA), which repealed the National Health Insurance Fund (NHIF) Act. The transition has been accompanied by government efforts to clear substantial outstanding debts owed by the defunct NHIF to healthcare facilities, with an allocation of KSh 4 billion in the 2025/26 financial year and further commitments to settle verified claims. While the High Court recently affirmed the constitutional validity of the SHIA, it also highlighted concerns regarding the initial chaotic rollout and its impact on access to healthcare services.

Kenya's healthcare landscape is undergoing a transformative shift with the operationalisation of the Social Health Authority (SHA) and the Social Health Insurance Act, 2023 (SHIA). This legislative overhaul aims to achieve Universal Health Coverage (UHC) by expanding health insurance to a broader segment of the population. Recent announcements by Treasury Cabinet Secretary John Mbadi confirm that over 31.2 million Kenyans have already registered under the SHA, a substantial increase from the approximately eight million previously covered by the National Health Insurance Fund (NHIF).

This significant registration milestone underscores the government's commitment to its UHC agenda, which seeks to ensure equitable access to quality healthcare services for all citizens. The transition from the long-standing NHIF to the newly established SHA, however, has not been without its complexities, particularly concerning the winding up of NHIF operations and the settlement of its outstanding financial obligations to healthcare providers. The government's proactive steps to address these legacy debts are crucial for building confidence in the new scheme and ensuring a seamless transition for both beneficiaries and service providers.

This article delves into the legal framework underpinning the SHA, the implications of the NHIF's repeal, the mechanisms for debt resolution, and the ongoing legal challenges that have shaped the implementation of Kenya's ambitious social health insurance reforms.

The journey towards Universal Health Coverage in Kenya is anchored in Article 43(1)(a) of the Constitution of Kenya, 2010, which guarantees every person the right to the highest attainable standard of health. To give effect to this constitutional mandate, the Social Health Insurance Act, No. 16 of 2023 (SHIA), was assented to on 19 October 2023 and commenced on 22 November 2023. This Act fundamentally restructured Kenya's health insurance framework by repealing the National Health Insurance Fund Act, 1998 (NHIF Act), and establishing the Social Health Authority (SHA) as the successor body.

The SHIA introduced a three-tiered fund structure, replacing the single NHIF fund. These new funds are the Primary Healthcare Fund (PHF), the Social Health Insurance Fund (SHIF), and the Emergency, Chronic and Critical Illness Fund (ECCIF). The PHF is designed to procure primary healthcare services, the SHIF serves as the main repository for contributions, and the ECCIF addresses specific needs for chronic and critical illnesses. The Social Health Insurance (General) Regulations, 2024, gazetted on 8 March 2024, further operationalized the SHIA, detailing aspects such as registration, contributions, and access to benefits.

The transition from NHIF to SHA has been a complex legal and administrative undertaking. The SHIA mandates every person resident in Kenya, including non-citizens with lawful residence, to apply for registration with the SHA. For salaried individuals, contributions to the SHIF are set at 2.75% of their gross salary, with a minimum monthly contribution of KSh 300 and no maximum cap, a departure from the previous NHIF structure. Employers are responsible for deducting and remitting these contributions to the SHA by the ninth day of each month.

Legal challenges have significantly impacted the implementation timeline. Initially, the High Court suspended SHIA's implementation until February 2024, citing a lack of proper public participation. However, the Court of Appeal later stayed this decision, allowing the government to proceed with implementation. A more recent High Court judgment delivered on 19 March 2026, while affirming the constitutional validity of the SHIF's legal framework, critically found that its nationwide rollout on 1 October 2024 was unreasonable and violated constitutional rights to health and human dignity. The court noted that the system was rolled out before necessary administrative and technological infrastructure was in place, leading to millions of Kenyans being temporarily denied access to essential healthcare. This judgment, however, opted for a structural interdict, directing the Ministry of Health and SHA to submit an action plan within 90 days to rectify the identified gaps, rather than nullifying the entire scheme.

A critical aspect of the transition involves addressing the substantial debts owed by the defunct NHIF to healthcare providers. Reports indicated that NHIF liabilities stood at approximately KSh 25.8 billion as of December 31, 2023, with total outstanding claims reaching KSh 33 billion by November 2024. The government has committed to clearing these debts, allocating KSh 4 billion in the 2025/26 financial year to settle verified claims. Furthermore, a directive by President William Ruto prioritised the settlement of smaller claims (below KSh 10 million), with larger claims subjected to verification by an independent committee. This move is intended to restore trust among healthcare facilities, many of whom were hesitant to onboard with SHA due to past non-payments.

The SHIA also introduces a requirement for registration as a precondition for accessing public services, a provision that was initially operationalized but later faced scrutiny. The Act also provides for a dispute resolution tribunal to handle grievances arising from its implementation, fostering accountability and transparency. Despite the progress in registration, ongoing legal challenges, such as a constitutional petition filed in Kiambu contesting the legality of SHA and digital health systems, continue to highlight the need for robust legal and operational clarity.

The registration of over 31 million Kenyans under the Social Health Authority represents a monumental step towards achieving Universal Health Coverage in Kenya. This expansion of health insurance coverage, facilitated by the Social Health Insurance Act, 2023, is poised to significantly impact healthcare access and financing across the nation. For legal practitioners, understanding the nuances of the SHIA, its accompanying regulations, and the ongoing judicial interpretations is paramount.

Attorneys should advise clients, particularly employers, on their obligations regarding mandatory registration and contribution remittances to the SHIF. Furthermore, the government's commitment to clearing NHIF debts presents opportunities and challenges for healthcare providers, necessitating careful verification and adjudication of claims. The recent High Court ruling, while affirming the SHIA's legality, underscores the importance of a constitutionally compliant and administratively sound rollout. Practitioners should remain vigilant of further regulatory developments, judicial pronouncements, and the operational refinements within the SHA, especially concerning access to services and the resolution of transitional issues, to effectively guide their clients through this evolving healthcare landscape.