President William Ruto speaks during the launch of the Social Health Authority (SHA) 922 Lifeline and National Ambulance Dispatch Centre in Nairobi on August 5, 2026./PCS
Nearly two years after the Social Health Authority (SHA) replaced the National Hospital Insurance Fund (NHIF), the government says the new health financing system has expanded coverage and access.
But as President William Ruto marks four years in office, challenges around system downtime, claims processing and patients being asked to pay out of pocket continue to test whether the transition has actually made healthcare easier for Kenyans.
At least 32.3 million Kenyans had registered with SHA as of August 18, 2026, according to CEO Mercy Mwangangi.
Mwangangi said the figure was nearly double the highest registration recorded under the former NHIF, which stood at 16.9 million.
President William Ruto flags off ambulances during the launch of the Social Health Authority (SHA) 922 Lifeline and National Ambulance Dispatch Centre in Nairobi on August 5, 2026./PCS
She was speaking during the National Health Summit, where she outlined SHA's progress two years after its establishment.
The number of health facilities accessible to SHA members has also increased from 8,667 during the NHIF period to 10,713.
Of these, 5,959 are government facilities, 4,534 private facilities and 541 faith-based organisations.
Mwangangi said SHA has facilitated 501,839 surgeries in two years, compared with 227,741 surgeries during a comparable two-year period under NHIF.
In renal care, beneficiaries increased from 8,831 under NHIF to 20,952 under SHA, while about 50,000 cancer patients have received cover compared with 29,473 under NHIF.
On critical care, Mwangangi said NHIF did not cover ICU services, while SHA has paid for ICU care for 28,031 beneficiaries.
She also reported that 9.3 million Kenyans have benefited from primary healthcare services under SHA, an increase of about 27 per cent compared with the NHIF period.
For maternity care, SHA has paid for deliveries involving 1.3 million mothers, with Sh17 billion spent on the services.
Overall, Mwangangi said SHA has paid out Sh178.5 billion across its various funds.
The figures point to a substantial expansion in the number of Kenyans registered and the range of services being financed under the new system.
The growth in registration is one of the clearest changes since NHIF was replaced.
By June 2026, Treasury Cabinet Secretary John Mbadi had reported that 31.22 million Kenyans had registered under SHA, up from about eight million registered under the defunct NHIF at the time cited by Treasury
By August, that figure had risen to 32.3 million, according to Mwangangi.
In January 2025, patients protested over problems with the SHA system after a technical failure at Kenyatta National Hospital disrupted some services for more than 48 hours.
KNH acknowledged that the downtime had caused delays in patient clearance and administrative processes before normal operations resumed.
A subsequent statement by the KNH chief executive directed the hospital to ensure patients, particularly those receiving dialysis and cancer treatment, continued receiving care during future system interruptions.
The transition has also left unresolved financial obligations inherited from NHIF.
In July, the government released Sh4 billion to begin settling verified outstanding NHIF claims of Sh10 million and below owed to healthcare facilities.
SHA said the payment programme would benefit 3,527 healthcare facilities.
The authority also said it was seeking National Treasury support in the 2026/27 financial year to settle verified outstanding claims exceeding Sh10 million involving 451 healthcare facilities.
Health Cabinet Secretary Aden Duale said in April that SHA had achieved a 74 per cent settlement rate in claims processing, with a 90-day timeline for payments across all levels of care.
He also confirmed the Sh4 billion allocation to begin settling verified claims inherited from NHIF.
The claims issue has also been linked to concerns over fraud and improper billing.
In June 2025, Duale said 31 private hospitals had been shut down over alleged fraudulent activities targeting the SHA Fund, including falsifying patient data, double-claiming and billing patients and SHA for the same services.
The government's continued payment of NHIF debts also shows that the transition did not wipe out the financial problems of the former insurer.
The Sh4 billion released in July was specifically meant to settle verified NHIF claims of Sh10 million and below.
Claims exceeding that amount involving 451 healthcare facilities were still awaiting budgetary support, according to SHA.
SHA has significantly expanded registration, with 32.3 million Kenyans now registered compared with NHIF's peak of 16.9 million.
The number of accessible facilities has also increased from 8,667 to 10,713.
The authority also reports higher utilisation of surgery, renal, cancer, maternity and critical-care services, alongside Sh178.5 billion paid through its various funds.
On July 25, President Ruto announced a comprehensive health insurance plan that will see all Community Health Promoters (CHPs) covered under the Social Health Authority (SHA).
Speaking when he hosted a section of Nairobi County’s community health promoters, the Head of State revealed that the national government has allocated Sh390 million to immediately jumpstart the process of onboarding these primary healthcare workers onto the state insurance scheme.
The move is part of a strategic push by the Kenya Kwanza administration to strengthen the country's grassroots healthcare infrastructure while ensuring that the very people tasked with promoting community wellness are themselves medically protected.
"I announce that the Government of Kenya, working with our counties, will make sure that every community health promoter has SHA as coverage," President Ruto stated.
Directing his instructions to Health Cabinet Secretary Aden Duale, who was in attendance alongside other senior state officials, the President stated that the executive is fully prepared to bankroll the transition.
"I would like to tell CS Aden Duale that we are ready to pay community health promoters more than Sh390 million. I would like to ask for that money to be taken to SHA," Ruto added.
