By Isaac Dan Onyancha
“The Social Health Authority was meant to revolutionize healthcare delivery, but instead it has exposed deep financial cracks, institutional confusion, and growing public distrust. Kenya must urgently fix its health financing model before it unravels completely.“
–Isaac Dan Onyancha
Let us accept it. The Social Health Authority (SHA) is not working.
What was meant to guarantee every Kenyan access to healthcare has turned into a bureaucratic maze filled with inefficiency, confusion, and frustration.
It now feels like a government long con rather than a transformative health initiative.
Across the country, patients are being turned away from health facilities, hospitals are struggling with unpaid claims, and counties are straining to keep the system functional.
The transition from the defunct National Hospital Insurance Fund (NHIF) was rushed, poorly coordinated, and implemented without adequate preparation.
The national and county levels of government appear out of sync, each waiting for the other to fix a system that is already failing the citizen.
President Ruto recently revealed that a philanthropist had paid contributions for one hundred and thirteen thousand Kenyans and appealed for others to do the same.
That revelation alone exposed the fragility of SHA’s financial foundation. If a national health system must depend on charity to sustain itself, then its policy architecture is already collapsing.
In counties such as Nyamira, even when fully compliant, monthly remittances range between five and seven million shillings.
That amount is a mere drop in the ocean when compared to the enormous costs of running hospitals and supporting healthcare personnel. When remittances delay by even two months, penalties accumulate before those payments are officially acknowledged.
Yet at the end of it all, these monies are still paid. SHA should therefore compensate or indemnify citizens and institutions that are forced to spend their own money during such delayed periods.
This situation reflects a much wider national crisis. The pool of SHA collections is severely depleted.
Reports from across the country indicate that nearly half of accredited facilities have gone for months without reimbursements, and some private hospitals have received less than thirty percent of their submitted claims.
Governors have already sounded the alarm over a funding deficit of about ten billion shillings, warning that the scheme may soon be unsustainable.
These figures confirm a painful reality. SHA’s financial base is weak, strained by low remittance levels, inefficient collection systems, and unpaid legacy debts inherited from NHIF.
The government may have overpromised universal health coverage without putting in place the necessary institutional and fiscal capacity to support it.
The result is both unjust and inhumane. Families that believed in the promise of universal health coverage are now paying out of pocket for treatment.
Health workers are demoralized, and hospitals—public, private, and faith-based alike—are operating under constant financial pressure.
To rescue SHA from total collapse, the government must act decisively.
It should first ensure that payments to health facilities are made promptly to restore confidence and stability.
It should also provide indemnity for periods when contributors and counties suffer from delayed remittances.
Finally, SHA’s financial records should be subjected to regular audits and published monthly to guarantee transparency and accountability.
SHA began as a noble idea anchored on the vision of equity in healthcare.
However, without urgent reform, transparency, and financial realism, it risks becoming one of the most expensive policy missteps in Kenya’s recent history.
The government must act now before the system sinks deeper into dysfunction and loses the trust of those it was created to protect.
- Isaac Dan Onyancha is the Director of Civic Education and Public Participation, Nyamira County. He is also a leadership and governance scholar.