Opinion: SHA’s Crisis Is Bigger Than a Health Insurance Problem

Kenya’s Social Health Authority (SHA) was supposed to mark a decisive break from the problems associated with the former National Health Insurance Fund (NHIF). Instead, less than two years into its operation, SHA is facing a credibility test that goes beyond technology or administrative teething problems.

The government says the system is making significant progress. By June 2026, the Ministry of Health reported that more than 31.39 million Kenyans had registered, with KSh147.37 billion paid in claims and more than 11,000 health facilities contracted.

Those figures matter. But so do the complaints coming from patients, healthcare workers and facilities.

The real question is not whether SHA has processed billions of shillings. It is whether an ordinary Kenyan can walk into a hospital, receive appropriate treatment and leave without being unexpectedly asked to pay money they believed their public health cover would provide.

The payment problem cannot be treated as a technical glitch

Healthcare providers need predictable reimbursement. Hospitals cannot sustainably provide services if they are uncertain about when legitimate claims will be paid.

The Ministry says SHA has achieved a 74 percent claims settlement rate and is enforcing a 90-day payment timeline.

But reports of outstanding government-linked health bills demonstrate why provider confidence remains important. In March, Nairobi Hospital reported more than KSh1.23 billion owed by SHA and the former NHIF combined.

For a hospital, delayed payment is not an accounting inconvenience. It affects cash flow, medicines, salaries, suppliers and ultimately patients.

If SHA wants healthcare facilities to trust the system, it needs to make payment performance transparent: how much is owed, how much has been verified, how much has been rejected and how long legitimate claims take to settle.

Fraud is a serious problem but so is public trust

SHA has also been dealing with fraud allegations and recovery efforts. In August, SHA said it had recovered KSh278 million from healthcare facilities that admitted to fraudulent claims, while other cases remained under investigation.

Cracking down on fraud is necessary. Every shilling recovered is money that can potentially return to patient care.

But the anti-fraud campaign must be accompanied by due process and transparency. Healthcare providers should know the rules, understand why claims are rejected and have a clear mechanism for challenging decisions.

A system that is aggressive against fraud but opaque in its enforcement can create another problem: legitimate providers may become afraid to treat complicated patients or submit legitimate claims.

The objective should be simple stop fraud without creating barriers to genuine healthcare.

The digital system must serve the patient, not the other way around

SHA is heavily dependent on digital systems for registration, verification, pre-authorisation and claims processing.

That can make healthcare financing faster and more accountable. But when the technology fails, the consequences are immediate.

The Ministry of Health itself has acknowledged system-downtime problems and directed contracted facilities not to deny patients treatment because of technical failures.

This is an important admission.

A patient's illness does not wait for a server to come back online.

The government therefore needs a reliable fallback mechanism whenever the SHA digital infrastructure experiences an outage. Patients should not become casualties of a technology problem they did not create.

The controversial deductions need transparency

Another issue that deserves public scrutiny is the reported 2 percent deduction from certain SHA claims linked to the Health Information Management System.

A legal dispute has emerged over payments involving technology firm Finsprint Limited, with court documents cited by the Daily Nation alleging that about KSh1.2 billion had been deducted from SHA claims by July 1.

This is precisely the kind of issue that demands maximum transparency.

Who authorised the deduction? What service is being purchased? Under what contract? Who benefits? Was the arrangement competitively procured? And is the charge ultimately reducing the amount available for patient care?

These questions should not be dismissed as political attacks. They are legitimate public-interest questions because SHA is funded through a national health financing system.

The government has begun fixing some problems

It would also be unfair to portray SHA as a complete failure.

The government has introduced measures to address operational problems, including removing tariff-locking mechanisms in the Public Officers Medical Scheme Fund and establishing rapid-response mechanisms for complaints involving unauthorised charges.

The Ministry has also been moving toward stronger claims audits, utilisation reviews, fraud detection and performance monitoring.

These reforms are welcome.

But the credibility of SHA will ultimately depend on implementation rather than announcements.

SHA needs an independent accountability culture

The biggest lesson from the NHIF era should be that public confidence cannot be built through government statements alone.

SHA needs measurable, independently verifiable performance indicators.

Kenyans should regularly be able to see:

1. Total contributions collected.
2. Total claims submitted.
3. Total claims paid.
4. Total claims rejected and the reasons.
5. Average payment time.
6. Outstanding verified claims.
7. Fraud detected and money recovered.
8. Administrative costs.
9. Contracts awarded and their beneficiaries.
10. System downtime.
11. Patient complaints and resolution rates.

That information should be published regularly in a format ordinary Kenyans can understand.

The political danger for Ruto

For President William Ruto, SHA is not merely a health-sector reform. It is one of the flagship promises of his administration.

That makes its performance politically consequential.

If Kenyans experience SHA as an improvement — affordable treatment, predictable coverage and fewer financial shocks — the government can claim that its Universal Health Coverage agenda is delivering.

If the public instead associates SHA with denied treatment, unexpected bills, delayed reimbursements and confusing bureaucracy, the reform could become a symbol of government failure.

The administration therefore has a narrow but important opportunity.

It should stop treating every criticism of SHA as opposition politics and instead treat credible criticism as an early-warning system.

The real test is the patient

SHA does not need more public-relations victories. It needs trust.

The government has inherited many of the structural problems that affected health financing under NHIF: limited resources, fraud, weak accountability, competing interests and enormous expectations from the public.

Those problems will not disappear simply because the institution has a new name and a digital platform.

The success of SHA should ultimately be measured in one place: the hospital bed, the clinic and the patient's experience.

If the system can pay legitimate claims promptly, prevent fraud, protect public money, function reliably, and ensure that Kenyans receive care without unexpected financial barriers, SHA can still become the foundation of a stronger universal healthcare system.

But if accountability remains weak and operational problems continue to be explained away as temporary challenges, Kenya risks repeating the very cycle that SHA was created to end.

The question is no longer whether SHA can survive. The question is whether it can earn the public's trust.