A comprehensive guide to Kenya's new Social Health Authority (SHA) system and how it affects your healthcare coverage.
Kenya's healthcare system entered a new era in 2024 with the launch of the Social Health Authority (SHA). If you've ever contributed to NHIF, or you're thinking of buying private medical insurance, here's everything you need to know about SHA and how it affects you.
SHA stands for Social Health Authority, the new government body that replaced NHIF (National Hospital Insurance Fund). It was established under the Social Health Insurance Act 2023 and aims to ensure universal access to healthcare for all Kenyans.
SHA has three separate health funds to cater to different needs:
1. Primary Healthcare Fund (PHCF)
Covers basic outpatient services like check-ups and minor treatments at public facilities (dispensaries, health centres).
2. Social Health Insurance Fund (SHIF) - The main insurance fund
Replaces the old NHIF. Covers inpatient and outpatient services at public and contracted private facilities.
3. Emergency, Chronic and Critical Illness Fund (ECCIF)
Covers serious conditions such as ICU, cancer treatment, dialysis, and accidents.
SHA is mandatory for:
📌 Even if you had NHIF or have private insurance, you still need to register for SHA.
No. Here's what happened:
🔍 Think of NHIF as a bus that dropped you off. SHA is a brand-new train. You need a new ticket to continue the journey.
SHA uses a monthly contribution model at 2.75% of gross income. Here's what you'll actually pay:
| Category | Monthly Gross Income | SHA Contribution (2.75%) |
|---|---|---|
| Entry-level employee | KES 30,000 | KES 825 |
| Mid-level employee | KES 80,000 | KES 2,200 |
| Senior employee | KES 150,000 | KES 4,125 |
| Self-employed/Informal | KES 20,000 (declared) | KES 550 (via MPESA/bank) |
| Unemployed | No income | Government subsidy or minimum rate (KES 300-500) |
Payment Methods:
❗Missing payments may delay or limit your access to services.
Registration is mandatory and requires biometric capture. Follow these steps:
Step 1: Gather Your Documents
Step 2: Visit Registration Point
Go to a designated SHA registration center (Huduma Centers, select hospitals, or county health offices) for biometric capture (fingerprints).
Step 3: Register Dependents
Add your spouse and children (biological or legally adopted) to your SHA account. They'll also need biometric capture.
Step 4: Receive Your SHA Number
You'll get a unique SHA membership number. Keep it safe—you'll need it to access healthcare services.
Step 5: Start Making Contributions
If employed, your employer handles this. If self-employed, set up monthly payments via MPESA or banking app.
📱 Alternative: SHA Mobile App
You can also register online via the SHA digital platform, but you'll still need to visit a center for biometric verification.
SHA provides a comprehensive benefits package through its three funds:
✅ What SHA COVERS:
❌ What SHA DOES NOT Cover:
Coverage Limit: SHA doesn't have an annual limit for covered services, but treatments must be medically necessary and provided at accredited facilities.
Once registered and contributing, you can access care at:
Services are accessed via biometric identification (like fingerprint scanning) at the facility. No SHA card needed—your fingerprint is your ID.
💡 Pro Tip: Confirm a facility is SHA-accredited before seeking treatment. Not all private hospitals participate in the SHA network.
Unlike NHIF's tiered system, SHA provides uniform coverage for all members, regardless of contribution amount. However, your access to services depends on:
1. Payment Status
Up-to-date contributors: Full access to all SHA benefits
Arrears (1-3 months): Limited access; emergency services only
Over 3 months in arrears: Services suspended until you clear payments
2. Type of Facility
Level 1-3 (Dispensaries/Health Centers): Primary care, basic diagnostics
Level 4 (County Hospitals): Specialist consultations, minor surgeries
Level 5-6 (Referral Hospitals): Complex procedures, specialized care
3. Referral System
For non-emergency cases, you must start at a lower-level facility and get a referral to access higher-level hospitals. Direct visits to Level 5-6 hospitals without referral may not be covered.
While SHA provides broad coverage, there are notable gaps where you might need private insurance or out-of-pocket payment:
🚨 Limited Access to Top-Tier Private Hospitals
Many premium private hospitals (e.g., The Nairobi Hospital's private wings, Karen Hospital) have limited SHA contracts. You may face long waits or be directed to public wards.
🚨 Medicine Formulary Restrictions
SHA only covers drugs on the Essential Medicines List. Newer, expensive medications (e.g., certain cancer drugs, biologics) may not be included. You'll pay out-of-pocket for non-formulary drugs.
🚨 No International Coverage
If you need medical treatment abroad, SHA won't cover it. Private insurance with global cover is essential for frequent travelers.
🚨 Queue Times and Service Delays
Public facilities and some SHA-contracted hospitals face high patient volumes. You may experience longer wait times compared to private insurance with priority access.
🚨 No Room Upgrades
SHA typically covers general wards. If you want a private room, better meals, or enhanced comfort, you'll pay extra or need private insurance.
💡 Bottom Line: SHA provides solid basic coverage, but private insurance bridges these gaps for premium care, faster service, and peace of mind.
Yes, and here's why:
| Feature | SHA | Private Insurance |
|---|---|---|
| Mandatory | ✅ Yes | ❌ No (optional but beneficial) |
| Contribution Type | % of income | Fixed premium |
| Type of Hospitals | Public + some contracted private | Broader, including top-tier hospitals |
| Luxury/private room access | ❌ No | ✅ Yes |
| Faster approvals/service | ❌ Slower | ✅ Faster |
| Coverage for extras | ❌ Basic care only | ✅ Specialized services + global cover |
| Annual Limit | No limit (for covered services) | Varies (KES 1M - 10M+) |
| Typical Monthly Cost | KES 550 - 4,125 (2.75% of income) | KES 3,000 - 15,000+ (fixed) |
Private insurance acts as a top-up, helping you access comfort, speed, and better facilities beyond SHA's basic offering.
SHA is designed to achieve universal health coverage, but certain groups benefit more than others:
✅ Low-Income Earners
If you earn KES 20,000-40,000/month, your SHA contribution (KES 550-1,100) provides access to comprehensive healthcare that would otherwise cost much more through private insurance.
✅ Informal Sector Workers
Jua kali workers, mama mbogas, boda boda riders, and small business owners who couldn't afford NHIF or private insurance now have affordable, structured healthcare access.
✅ People with Chronic Conditions
SHA's dedicated fund for chronic and critical illnesses means conditions like diabetes, cancer, and kidney disease receive better, more consistent coverage than under NHIF.
✅ Large Families
Unlike private insurance that charges per person, SHA's 2.75% contribution covers your entire household (spouse + children) at no extra cost.
⚠️ High-Income Earners Face Higher Costs
If you earn KES 200,000+/month, your SHA contribution (KES 5,500+) might exceed what you'd pay for basic private insurance, yet you still get the same coverage as someone paying KES 550. Consider SHA + premium private insurance for value.
Let's see how SHA works in real-life situations for Kenyans:
Scenario 1: Mary - Maternity Care
Profile: Expectant mother, earns KES 50,000, contributes KES 1,375/month
Experience: Mary registered for SHA early in her pregnancy. She received antenatal care at a county hospital, delivered safely, and all costs (pre-natal, delivery, postnatal) were fully covered. She paid KES 0 out of pocket. Without SHA, delivery alone would cost KES 30,000-80,000.
Scenario 2: John - Emergency Surgery
Profile: Boda boda rider, earns KES 25,000, contributes KES 688/month
Experience: John had an accident and needed emergency surgery. He was rushed to Kenyatta National Hospital, underwent surgery, stayed 5 days in the ward, and received post-op care. SHA covered everything through the Emergency Fund. Total bill avoided: KES 150,000+.
Scenario 3: Jane - Diabetes Management
Profile: Teacher, earns KES 70,000, contributes KES 1,925/month
Experience: Jane has Type 2 diabetes. SHA covers her monthly check-ups, blood sugar tests, and insulin from the Essential Medicines List. However, when her doctor recommended a newer, more expensive insulin brand, Jane had to pay KES 8,000/month out of pocket as it wasn't on the formulary.
Scenario 4: Peter - Private Hospital Preference
Profile: IT professional, earns KES 120,000, contributes KES 3,300/month
Experience: Peter wanted treatment at Nairobi Hospital's VIP wing. SHA only covered general ward rates at the hospital. Peter had to pay KES 45,000 out of pocket for the private room upgrade. He realized he needed private insurance as a top-up for his preferences.
Q: Can I opt out of SHA if I have private insurance?
A: No. SHA is mandatory for all Kenyan citizens and residents. You must contribute even if you have comprehensive private cover.
Q: What happens if I lose my job? Do I still pay SHA?
A: Yes, but your contribution changes. As an unemployed person, you may qualify for government subsidies or pay a reduced minimum rate (KES 300-500/month). Contact SHA to update your employment status.
Q: Can I use SHA outside Kenya?
A: No. SHA only covers healthcare services within Kenya. If you travel frequently or need international cover, get private insurance with global coverage.
Q: How long does registration take?
A: Registration at a physical center takes 30-60 minutes (including biometric capture). Your SHA number is issued immediately or within 24 hours. Contributions must be up-to-date to access services.
Q: What if I'm in arrears? Can I still get emergency treatment?
A: Yes. SHA will cover emergency services even if you're in arrears. However, non-emergency services will be suspended until you clear your payments.
Q: Can I add my aging parents to my SHA cover?
A: No. SHA only covers your spouse and dependent children (under 18, or up to 25 if in school). Aging parents must register separately or be covered by their own contributions.
Q: Are pre-existing conditions covered under SHA?
A: Yes! Unlike some private insurance, SHA covers pre-existing conditions from day one. This is a major benefit for people with chronic illnesses.
Get the most out of your SHA membership with these practical tips:
1. Register Early and Keep Records
Don't wait until you're sick. Register immediately, save your SHA number, and keep payment receipts. Early registration ensures seamless access when you need it.
2. Know Which Hospitals Are Accredited
Before seeking care, confirm the facility is SHA-accredited. Not all hospitals participate. Check the SHA website or call their helpline for an updated list.
3. Use the Referral System Properly
Start at lower-level facilities (dispensaries, health centers) for non-emergencies. This ensures your visit is covered and helps you get proper referrals to specialists when needed.
4. Maintain Up-to-Date Biometrics
If your fingerprints change (injury, aging), update your biometric data at a SHA center. This prevents access issues at hospitals.
5. Combine SHA with Affordable Private Insurance
SHA covers the basics brilliantly, but consider adding a mid-range private insurance plan (KES 3,000-7,000/month) to access better facilities, private rooms, and faster service. The combination gives you comprehensive, affordable coverage.
6. Leverage Preventive Care Benefits
SHA covers free health screenings, vaccinations, and wellness check-ups. Use these preventive services to catch health issues early and avoid expensive treatments later.
7. Self-Employed? Declare Income Realistically
Under-declaring income saves on contributions now but may limit your access if SHA implements income-verification checks. Aim for a realistic declared income that balances affordability and credibility.
8. Keep SHA Helpline Handy
Save SHA's customer care contacts. If you face issues accessing services, payment problems, or need clarification, their support team can resolve most issues quickly.
At Learn with Keryl, I believe that clarity builds confidence. SHA is a major shift in Kenya's healthcare journey. Whether you're considering a private cover or wondering where your NHIF contributions went, now you know where you stand and how to move forward.
Need help picking a cover that works with SHA or have more questions?
Talk to me today. I'll simplify the process for you.
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