SHA: A Healthcare Reform Turning Into a Burden for Kenyans

When the government rolled out the Social Health Authority (SHA) to replace the National Health Insurance Fund (NHIF), it promised universal healthcare coverage for all Kenyans. The vision was bold: a system where every citizen, regardless of income, would access quality healthcare without the burden of crippling medical bills. Yet, just months into its implementation, glaring cracks are already showing—exposing why the SHA system may be doing more harm than good. One of the most immediate concerns is the steep monthly deductions from workers’ paychecks. Unlike NHIF’s fixed contributions, SHA adopts an income-based model, meaning high deductions for middle-class and salaried workers. This comes at a time when Kenyans are already grappling with high taxes, inflation, and unemployment. For many families, SHA deductions feel less like a healthcare solution and more like another form of government taxation. The transition from NHIF to SHA has also been chaotic. Hospitals and clinics across the country report confusion over reimbursement processes, leaving patients stranded with unpaid bills. Some hospitals have even started rejecting SHA cards due to unclear guidelines, forcing patients to pay cash. This poor implementation undermines trust in the system and punishes ordinary Kenyans in their most vulnerable moments. NHIF was notorious for corruption scandals and mismanagement of funds. Unfortunately, SHA is shaping up to follow the same path. There is little transparency in how funds are being collected, pooled, and disbursed. Without robust oversight mechanisms, Kenyans fear that SHA may simply be another cash cow for corrupt officials rather than a genuine healthcare reform. The majority of Kenyans work in the informal sector, where incomes are unstable and unpredictable. Forcing them into mandatory contributions creates undue pressure, especially when the promised services are not guaranteed. Many informal workers are already reluctant to register, fearing they will be penalized while still paying for healthcare out-of-pocket. Even with a rebranded financing model, Kenya’s healthcare infrastructure remains overstretched and underfunded. Long queues, understaffed hospitals, lack of essential drugs, and dilapidated facilities mean that access to quality healthcare is still a mirage. SHA may collect billions, but if these funds are not invested in strengthening facilities and training healthcare workers, Kenyans will continue to suffer. Healthcare systems thrive on trust, and SHA is rapidly losing it. The government failed to adequately educate citizens on how the new system works, leaving room for misinformation and fear. Many Kenyans now view SHA not as a safety net, but as another government scheme designed to squeeze money from struggling households. The idea behind the Social Health Authority was noble—to ensure that every Kenyan can walk into a hospital and get treated without worrying about the bill. But in practice, SHA has become another burden in a country already weighed down by high living costs, poor governance, and weak healthcare infrastructure. Unless urgent reforms are made to enhance transparency, reduce the financial strain, and strengthen service delivery, SHA risks collapsing before it even takes root, leaving Kenyans worse off than they were under NHIF.