In a major policy shift aimed at accelerating progress toward Universal Health Coverage (UHC) and rebuilding public trust in its revamped health insurance system, Kenya’s Ministry of Health has announced significant enhancements to the Social Health Authority (SHA) benefits. The recent upgrade sees oncology care coverage per household increased by KSh 150,000—from KSh 440,000 to KSh 550,000—and a six-fold rise in Intensive Care Unit (ICU)/High Dependency Unit (HDU) coverage, now extended from KSh 4,600 to KSh 28,000. These improvements were declared on March 5, 2025, by Health Cabinet Secretary (CS) Deborah Barasa, amid ongoing efforts to rectify persistent issues that have plagued the SHA since its launch in October 2024.

Strengthening the Pillars of Universal Health Coverage

Kenya’s ambitious drive toward UHC has long been seen as pivotal for ensuring that every Kenyan gains access to essential healthcare services without the risk of financial hardship. The recent enhancements to the SHA are designed not only to provide broader financial protection for families facing the high costs of cancer treatment and critical care but also to restore confidence in a system that has struggled with technical and service delivery challenges since its inception.

Under the old National Hospital Insurance Fund (NHIF), millions of Kenyans had access to basic health insurance; however, systemic inefficiencies, high default rates, and inadequate benefit packages led to mounting public dissatisfaction. The SHA was introduced as a replacement with the promise of more comprehensive coverage and streamlined services. Yet, since its rollout, the new system has faced significant hurdles—including delayed claims processing, inadequate coverage levels, and persistent technical glitches—that have hindered optimal service delivery.

CS Deborah Barasa, in her statement to the media, emphasized that the recent increases in oncology and ICU/HDU coverage are part of a broader commitment by the Ministry of Health to create a complete and financially viable health system. “These enhancements reaffirm our dedication to providing a comprehensive health service that not only meets the needs of our citizens but does so in a way that is sustainable and equitable,” Barasa asserted.

Expanding Cancer Care Coverage: A Lifeline for Families

Cancer remains one of the leading causes of morbidity and mortality in Kenya. The high costs associated with cancer diagnosis, treatment, and palliative care have long placed an immense financial burden on households. Prior to the recent upgrade, the coverage for oncology care under SHA stood at KSh 440,000 per household—a sum that many critics argued was insufficient given the escalating costs of modern cancer therapies, which can easily run into millions of shillings over the course of treatment.

By raising this coverage to KSh 550,000, the Ministry of Health aims to alleviate some of the financial pressures faced by families affected by cancer. For many households, this additional KSh 150,000 could mean the difference between receiving timely treatment and facing catastrophic health expenditures. In the context of Kenya’s broader UHC goals, this move is significant as it addresses both the clinical and financial dimensions of healthcare—a dual challenge in the fight against non-communicable diseases.

Experts have noted that comprehensive cancer care is a critical component of any UHC strategy. The increased funding will potentially cover a broader range of services, from diagnostic tests and chemotherapy to surgical interventions and follow-up care. Moreover, with the global incidence of cancer on the rise, enhanced coverage could also incentivize investments in early detection and preventive care programs—a crucial strategy for reducing long-term treatment costs and improving patient outcomes.

A Six-Fold Increase in ICU/HDU Coverage

In addition to the improvements in oncology care, the Ministry of Health announced a dramatic increase in ICU/HDU coverage—from a meager KSh 4,600 to KSh 28,000. This six-fold jump in coverage is particularly noteworthy given the critical role that intensive and high dependency care play in managing severe and life-threatening conditions, such as complications from chronic illnesses, severe infections, and traumatic injuries.

The COVID-19 pandemic underscored the vital importance of robust critical care services. Despite the subsequent recovery, many Kenyan health facilities continue to grapple with inadequate ICU/HDU capacities, a challenge that has had severe repercussions during health emergencies. By expanding coverage, the SHA intends to ensure that patients requiring intensive care are not forced to bear prohibitive out-of-pocket expenses. This enhancement is expected to encourage more timely and effective treatment interventions, potentially reducing mortality rates and improving overall health outcomes.

Addressing Systemic Challenges: The SHA Roadmap

Since the SHA was launched in October 2024, a series of operational and technical challenges have marred its implementation, resulting in suboptimal service delivery. These issues have ranged from delayed claims processing and inadequate provider reimbursements to systemic glitches in the health information systems that manage patient data. Acknowledging these shortcomings, the Ministry of Health has embarked on a comprehensive corrective program aimed at restoring public confidence and ensuring the scheme meets its intended goals.

Key measures include:

Onboarding High-Volume Hospitals onto the Health Information Exchange (HIE) System

The Ministry plans to integrate 15 high-volume hospitals into the Health Information Exchange (HIE) system. This integration is intended to facilitate seamless patient data interchange and coordinate care across multiple facilities. The HIE system is expected to reduce redundancies, ensure accurate claims processing, and provide healthcare providers with real-time access to patient records—thereby improving the overall quality of care.

Establishing a 24-Hour Call Centre

To further enhance service delivery, the Ministry is setting up a 24-hour call centre. This facility will assist Kenyans with healthcare access, registration, and claims tracking. The call centre is part of a broader strategy to address public concerns and provide timely support to individuals navigating the complexities of the SHA system. With round-the-clock availability, the call centre aims to become a critical touchpoint for patients and healthcare providers alike.

Nationwide Training on Claims Processing

Recognizing that efficient claims processing is pivotal to the success of the SHA, the Ministry will roll out a nationwide training programme for healthcare workers. This initiative is designed to equip staff with the necessary skills to process claims accurately and expedite payments. In conjunction with the training programme, a tracker dashboard will be implemented to enable real-time monitoring of claims by county governments and medical facilities. This measure is expected to enhance transparency and accountability, ensuring that healthcare providers receive timely reimbursement and that patients experience uninterrupted care.

Fixing Technical Glitches and Enhancing System Reliability

CS Barasa has assured the public that the Ministry is working diligently to resolve the technical issues that have plagued the SHA since its launch. Investments in IT infrastructure and system upgrades are underway to ensure that the platform operates smoothly and reliably. The aim is to create a user-friendly system that meets international standards for efficiency and data security—a key factor in sustaining long-term public trust.

The Broader Impact on Kenya’s Healthcare Landscape

The SHA enhancements come at a critical juncture for Kenya’s healthcare system, which has been under immense pressure from rising costs, increasing disease burdens, and the legacy of previous systemic inefficiencies. The new benefits not only provide immediate financial relief for patients and their families but also signal a commitment by the government to fundamentally reform the healthcare financing landscape.

Improving Access to Critical Health Services

With over 18 million Kenyans enrolled in the SHA and more than 500,000 already benefiting from the scheme, the recent improvements are poised to have a substantial impact on access to essential healthcare services. The increased oncology and ICU/HDU coverage will particularly benefit vulnerable populations—ensuring that those in critical need are not denied care due to financial constraints.

Enhancing Public Trust in Health Insurance

Since its inception, the SHA has been marred by challenges that have eroded public confidence in the system. By addressing these issues head-on and rolling out tangible benefits, the Ministry of Health is working to rebuild trust among Kenyan citizens. A more reliable and responsive health insurance system is crucial for achieving the broader goal of UHC, as public buy-in is essential for the scheme’s success.

Lessons from the Transition from NHIF to SHA

The transition from the long-standing NHIF system to the new SHA has not been without its hurdles. Only 7.1 million of the 16.2 million former NHIF members are actively contributing to the new scheme, leaving a significant gap with over 8.8 million members dormant in the previous system—a discrepancy that has raised concerns about revenue sustainability. The government, led by President William Ruto, has taken measures to ensure that all medical facilities with claims of KSh 10 million or less receive full reimbursement. These corrective measures aim to stabilize the system while laying the groundwork for future reforms.

Economic Implications and the Path to Sustainable Healthcare Financing

The improved SHA benefits have broader economic implications. By mitigating catastrophic health expenditures, the enhanced coverage can protect households from impoverishment due to medical emergencies. This financial protection is particularly important in a developing economy like Kenya, where out-of-pocket expenditures on health can drive millions of families into poverty each year.

Moreover, by ensuring that healthcare providers are reimbursed promptly and accurately, the government is fostering a more stable and predictable financing environment for hospitals and clinics. This, in turn, is likely to lead to improved service delivery, increased investment in healthcare infrastructure, and better overall health outcomes. With a more robust health insurance system, Kenya is also better positioned to attract private sector investment and public-private partnerships—key components for scaling up healthcare services in the long term.

Regional and Global Perspectives on UHC

Kenya’s efforts to enhance its health insurance system are part of a broader trend across Africa and the developing world, where countries are increasingly prioritizing UHC as a cornerstone of economic and social development. Successful UHC systems in countries such as Thailand and Rwanda have demonstrated that comprehensive health coverage can drive improvements in population health, reduce inequalities, and spur economic growth. Kenya’s SHA reforms are closely watched by neighboring countries and international development agencies, as they offer valuable insights into the challenges and opportunities associated with large-scale health financing reforms.

International organizations, including the World Health Organization (WHO) and the World Bank, have consistently emphasized the importance of strong, well-managed health insurance systems for achieving UHC. By aligning its policies with global best practices, Kenya is not only addressing its internal challenges but also contributing to the broader discourse on sustainable healthcare financing in low- and middle-income countries.

The Road Ahead: Challenges and Opportunities

Despite the recent improvements, significant challenges remain. The SHA will need to overcome operational inefficiencies, technological glitches, and persistent gaps in public awareness to achieve its full potential. Ensuring timely claims processing and preventing fraud will require ongoing investments in IT infrastructure and human capital. The Ministry of Health’s commitment to nationwide training and the rollout of a comprehensive monitoring dashboard are positive steps, but sustained political and financial support will be crucial for long-term success.

Furthermore, bridging the gap between active and inactive members remains a priority. With a substantial portion of the former NHIF members not actively participating in the new scheme, efforts must be made to re-engage these individuals and ensure that the benefits of SHA are extended to all segments of the population.

Conclusion: A Bold Step Toward Universal Health Coverage

The decision by Kenya’s Ministry of Health to increase oncology care coverage by KSh 150,000 and expand ICU/HDU benefits by six-fold under the SHA marks a pivotal moment in the country’s journey toward Universal Health Coverage. These enhancements are not merely adjustments in financial figures—they represent a renewed commitment to providing quality, accessible healthcare for every Kenyan. By addressing both the clinical and administrative challenges that have long undermined public confidence, the Ministry of Health is setting the stage for a more resilient and equitable health system.

As Kenya continues to refine and expand the SHA, the positive impact on households, healthcare providers, and the broader economy is expected to grow. With over 18 million enrolled beneficiaries and a series of corrective measures already underway, the SHA reforms offer a promising blueprint for sustainable healthcare financing—not just for Kenya, but for other countries striving to achieve UHC.

In an era where access to quality healthcare is increasingly recognized as a fundamental human right, these reforms reaffirm the government’s commitment to safeguarding the health and well-being of its citizens. The road to UHC is undoubtedly challenging, but with strategic investments in both service delivery and system infrastructure, Kenya is making significant strides toward a future where no one is left behind.

By tackling the persistent issues that have plagued the SHA, and by introducing robust measures to enhance claims processing, data management, and public engagement, Kenya is poised to set new standards in health insurance management. The enhanced benefits are a testament to the government’s resolve to create a healthcare system that is both inclusive and financially sustainable—a system that not only meets the current needs of the population but is also adaptable to future challenges and opportunities.

In the long run, the success of the SHA will be measured not only in terms of financial metrics but also by the improved health outcomes, reduced poverty levels, and enhanced quality of life for millions of Kenyans. As the nation embarks on this transformative journey, the commitment to continuous improvement and innovation in healthcare will remain a cornerstone of its development agenda, ensuring that the promise of Universal Health Coverage becomes a lived reality for all.

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photo source: Google

By: Montel Kamau

Serrari Financial Analyst

7th March, 2025