OJIAMBO: SHA East Africa’s most ambitious push for universal healthcare

In the heart of East Africa, a quiet revolution is underway. As nations across the continent strive for health equity, each charting a unique course shaped by history and resources, Kenya has launched one of the region’s most ambitious healthcare reforms in a generation: the Social Health Authority.

This bold initiative seeks to create a unified, mandatory national insurance pool, aiming to ensure that no Kenyan — from a market trader in Kisumu to a corporate executive in Nairobi — is left without a financial safety net in times of illness or injury.

SHA emerges against a rich tapestry of regional innovation, where each neighbour offers lessons in both promise and complexity. Rwanda stands as a shining beacon, having achieved more than 90 per cent health coverage through its community-based Mutuelle de Santé — a success built on decades of sustained political will and meticulous implementation.

Tanzania and Ethiopia illustrate the evolving challenges of hybrid systems, providing data on enrolment and sustainability. Uganda’s recent passage of a national insurance law marks a hard-won legislative milestone, while countries like Malawi and Mozambique highlight the tax-funded pathway, innovating through partnerships to stretch limited resources. Even in fragile states, the pursuit of health equity endures, laying the groundwork for future systems.

Against this backdrop, Kenya’s model distinguishes itself through its mandatory, unified structure, directly confronting the entrenched divide between formal and informal economies. Its three-pillar design — targeting primary care, chronic illness and catastrophic coverage — signals a sophisticated understanding that true universal healthcare demands prevention, continuity and financial protection, not just hospital access.

The ambition, however, is matched by scale. “Kenya is committing around 4.5 percent of its GDP to Healthcare,” Dr Adriana Midamba, a global healthcare expert with the US State Department and an academic at Indiana University, says. “While this is below the WHO recommended 15 percent, it is still among the best commitments in Eastern Africa.”

Yet this commitment faces inevitable friction. Enrolling millions of informal sector workers presents a colossal logistical hurdle. Digital systems must be rolled out reliably, public trust earned through transparency and legal challenges over contribution models resolved. These are the growing pains of systemic change — Rwanda itself faced formidable resistance in its early years.

Dr Midamba suggests Kenya look beyond its borders for implementation insights. “Kenya and other East African countries should closely look at the Indian model, which has a strong healthcare system with AI-integrated systems,” she advises, highlighting shared historical ties and the potential for technology to leverage a youthful population.

Ultimately, SHA is more than a health policy — it is a statement about national solidarity and the kind of social contract Kenya wishes to build. Its success hinges on sustained political will, adaptive learning and increased investment. Dr Midamba stresses that “even with the teething problems in enrolment, SHA remains a great initiative”, but urges committing “at least 10 per cent of GDP to the programme and involving the business community for greater success.”

Importantly, Kenya’s push should not be seen as a criticism of neighbouring systems, but as a complementary contribution to Africa’s expanding repository of homegrown solutions. As Dr Midamba emphasises, universal health coverage on the continent is a collective march shaped by shared learning, mutual inspiration and regional perseverance.

As Kenya navigates this complex journey, the stakes extend far beyond its borders. If it can translate bold vision into tangible outcomes — earning trust, ensuring sustainability and delivering better health — it will offer a viable blueprint for an entire continent marching, collectively, toward the promise of health for all.

Ojiambo is a health expert and senior associate atGlobal Centre for Policy and Strategy, a Nairobi-based think-tank