SHA collections reach Sh142bn as 29.4 million Kenyans enrol, Duale announces

Kenya has collected Sh142 billion in premiums under the Social Health Authority (SHA) and enrolled 29.4 million citizens, Health Cabinet Secretary Aden Duale announced Friday, signalling major progress in the country’s push toward Universal Health Coverage (UHC).

Presenting a comprehensive status report during the 29th Ordinary Session of the Intergovernmental Budget and Economic Council (IBEC), chaired by Deputy President Kithure Kindiki, Duale said the new health financing system is rapidly expanding access to services while strengthening accountability across the sector.

According to the update, Sh102.3 billion has already been disbursed to health facilities for services provided to patients, a move the Ministry of Health says has improved cash flow and service delivery in public, faith-based and private institutions.

“Kenya is making steady and measurable progress toward Universal Health Coverage. The transition from NHIF to SHA is delivering results in terms of enrolment, collections and service access,” Duale told the council, which brings together national and county governments to coordinate fiscal and economic policy.

The 29.4 million registrations represent a sharp rise from the seven million Kenyans who were previously covered under the now-defunct National Hospital Insurance Fund (NHIF).

Of those enrolled, more than 8 million Kenyans have already accessed primary healthcare services, while over 3.2 million have benefited from services under the Social Health Insurance Fund component.

A total of 10,277 health facilities are currently transacting under SHA, including 5,672 county facilities, 533 faith-based institutions and 4,072 private providers.

County governments emerged as the largest beneficiaries of SHA payments, receiving about 57 per cent of primary healthcare disbursements, followed by private facilities at 36 per cent and faith-based organisations.

Nairobi recorded the highest primary healthcare payments, followed by Kiambu, Mombasa, Kakamega and Bungoma, reflecting both population size and service utilisation patterns.

Data presented to IBEC shows growing demand for inpatient and specialised services.

Between October 2024 and January 2026, more than 1.8 million patients received inpatient care, while maternity and child health services accounted for over 893,000 cases.

Surgical procedures stood at nearly 300,000, alongside rising demand for imaging, oncology, renal and critical care services.

The council also confirmed progress in restoring free maternal healthcare, with the National Treasury directed to immediately release Sh2 billion to kick-start the programme at Level 2 and Level 3 health facilities.

Health officials reported that between October 2024 and December 2025, facilities conducted 583,298 normal deliveries and 326,684 Caesarean sections under the maternity package.

The estimated annual funding requirement for the programme at lower-level government and faith-based facilities stands at about Sh2.04 billion.

Counties were further encouraged to support UHC by paying SHA premiums for vulnerable residents and indigent households.

Murang’a, Migori, Trans Nzoia and Mombasa were cited as leading examples, having already financed coverage for thousands of low-income residents.

Beyond financing, IBEC reviewed the rollout of critical medical infrastructure under the National Equipment Service Programme (NESP).

All county governments have signed up for the installation of specialised equipment. Still, governors were urged to expedite the signing of addenda to operationalise equipment maintenance funding and ensure optimal use.

However, the meeting also flagged operational bottlenecks that could delay service delivery and payments.

A total of 1,287 county-managed health facilities have yet to receive primary healthcare funds due to missing or incorrect bank details, mismatched facility names, incomplete SHA e-contracting or reconciliation challenges involving facility identification codes.

The Ministry of Health said funds had been returned by banks in several cases because of invalid account information, and counties were asked to urgently submit accurate and verifiable banking details to enable settlement of pending bills.

In addition, all county facilities were instructed to fast-track submission of bank account information to support clearance of outstanding SHA claims.

While the overall performance of health providers was rated positively, Duale said the government would take a firm stance against fraud and abuse.

The SHA review identified several irregularities, including falsified documentation, incomplete claim submissions, and “upcoding” — where outpatient cases are incorrectly billed as inpatient services or procedures are exaggerated to attract higher payments.

Other issues included double-billing of benefits, such as overlapping maternity and inpatient claims, and facilities seeking reimbursement for services outside their approved capacity.

“The Ministry and SHA will not pay any questionable claims or those submitted without proper supporting documentation,” Duale said, adding that strict verification measures were necessary to protect public funds.

Despite these concerns, the review found strong compliance in most facilities.

Many hospitals adhered to approved tariffs, submitted claims within required timelines and demonstrated sound clinical justification for treatments. Health providers were also commended for cooperating with audits and record verification.

The council also reviewed the rollout of Accident and Emergency services, currently operational in Level 6 hospitals.

So far, 8,105 claims worth Sh45.4 million have been submitted, though only 15 per cent qualified for payment due to misuse or ineligible cases.

The Ministry plans to expand emergency coverage to 1,070 facilities ranging from Level 4 to Level 6 hospitals at an estimated annual cost of Sh500 million, with priority given to higher-level referral facilities and phased onboarding of lower-level providers.

Meanwhile, the government reported progress in targeted social health interventions, including the Teen Mothers Programme, which has registered 48,273 teenage mothers across 44 counties through an assisted registration system.

The highest monthly registrations were recorded in November 2025.

Deputy President Kindiki said the IBEC meeting had confirmed that cooperation between national and county governments would be critical to sustaining the gains made under SHA and achieving full UHC coverage.

The council resolved that counties must strengthen facility financial management, complete contracting processes and support enrolment drives, especially among informal sector workers and vulnerable populations.

Duale warned that delays in administrative compliance at county level could undermine the gains already achieved in expanding coverage and improving access to care.

With enrolment approaching 30 million and disbursements exceeding Sh100 billion, the government says the focus will now shift to improving service quality, eliminating fraud and ensuring that every Kenyan can access affordable healthcare without financial hardship.

The IBEC session concluded with a commitment from both levels of government to accelerate reforms and address operational gaps as the country moves closer to delivering Universal Health Coverage for all.