As Kenya shifts from
NHIF to the Social Health Authority, the new health financing system is
changing how millions of Kenyans access and pay for care.
For years, a hospital visit has been more than a medical experience for many Kenyan families. It has also been a financial calculation: Can I afford the consultation? What happens if I need medicine? Who will pay if the illness becomes serious?
The Social Health Authority was introduced to change that reality by making healthcare financing broader and protecting households from high medical costs.
SHA replaced the National Hospital Insurance Fund under the Social Health Insurance Act, 2023. The new system is built around the Primary Healthcare Fund, Social Health Insurance Fund and Emergency, Chronic and Critical Illness Fund.
The government says the arrangement is intended to finance different levels of care and reduce the amount families pay directly when seeking treatment.
But SHA is now entering another important phase: the migration of health facilities from the SHA Provider Portal to the Health Management Information System. In an October 2 clarification, Health Cabinet Secretary Aden Duale said hospitals had been working with two systems—HMIS for their daily operations and the SHA portal for claims and related transactions.
He said this duplication had increased administrative work and, in some cases, contributed to longer patient waiting times.
Under the new arrangement, a hospital’s HMIS becomes the primary system through which healthcare services and related information are managed, while being connected to SHA and other health-sector systems.
Duale explained that the goal is not simply to replace one portal with another, but to connect the different parts of the healthcare ecosystem. He described the intended result as “one hospital system that can securely communicate with the different systems supporting healthcare delivery.”
The transition is already underway. The Ministry of Health says all 6,427 public level 2 to level 4 facilities have completed migration.
At level 5, four public facilities have transitioned while 23 are still at different stages. Of 518 contracted faith-based facilities being supported by government, 38 have completed the move.
Kenyatta National Hospital and Kenyatta University Teaching, Referral and Research Hospital are also expected to complete their transition shortly, while other Level 6 facilities have until October 30.
The government has extended the migration deadline to October 30 to give facilities still completing the process more time and technical support.
Duale has also assured Kenyans that the transition should not interrupt access to healthcare. “No patient will be denied access to healthcare services because a facility has not yet fully transitioned to HMIS,” he said.
For patients, the promised change is practical. Instead of health workers entering or transferring the same information repeatedly between separate systems, data captured during care can be shared with authorised systems.
The Ministry says this could reduce paperwork and waiting time, improve continuity of care and make admissions, consultations, billing and claims processing more efficient. Proper integration could also allow authorised health workers to access relevant medical information when a patient receives care at another facility.
For SHA, the shift could also affect how claims are handled. Linking claims more closely to actual patient encounters and services delivered is expected to improve verification and reduce inconsistencies, duplicate claims and other irregularities.
The government expects better-quality digital information to support more efficient claims processing and health-sector planning.
The wider reform, however, is still a work in progress. Private facilities with existing HMIS platforms are undergoing certification under the Digital Health Act, with the Digital Health Agency reporting that 28 platforms have so far been certified.
The success of the transition will depend on reliable connectivity, staff training, technical support, data security and whether the systems work smoothly in busy facilities.
For millions of Kenyans, the real test of SHA will therefore happen beyond government statements and statistics. It will be felt in the waiting room, at the pharmacy counter and in the family budget after an illness.
If the new digital integration delivers the promised shorter processes, better records and smoother claims, it could make healthcare easier to navigate.
If implementation problems persist, the gap between policy and the patient experience will remain one of SHA’s biggest challenges.
Fourth-year student, Mount Kenya University
