SHA collected Sh20.9bn, disbursed Sh18.2bn in claims since October 2024- Ministry

The Social Health Authority (SHA) headquarters in Nairobi. The authority has processed claims from both public and private hospitals, with disbursements totalling Sh18.2 billion.(Photo: SHA)

By Maureen Kinyanjui
Thursday, February 27, 2025

According to the ministry, Sh16.97 billion of the funds went toward Social Health Insurance Fund (SHIF) claims, while Sh1.33 billion was allocated to Primary Health Care capitation.

The Social Health Authority (SHA) has collected Sh20.9 billion since its launch in October 2024, the Ministry of Health has announced.

The authority has processed claims from both public and private hospitals, with disbursements totalling Sh18.2 billion.

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According to the ministry, Sh16.97 billion of the funds went toward Social Health Insurance Fund (SHIF) claims, while Sh1.33 billion was allocated to Primary Health Care capitation.

"The claims are categorised into paid Sh18.2 billion, out of which Sh16.97 billion relates to SHIF claims and Sh1.33 billion to Primary Health Care capitation," the ministry stated on Wednesday.

The government said it is committed to ensuring healthcare providers receive timely reimbursements, preventing disruptions in service delivery.

"By facilitating payments across both public and private health facilities, the government is safeguarding uninterrupted healthcare access for all Kenyans, reinforcing its dedication to achieving Universal Health Coverage (UHC) under Taifa Care," the ministry said.

The ministry highlighted that the minimum contribution for the most vulnerable households to SHIF is set at Sh300, a reduction from the Sh500 previously charged under the National Health Insurance Fund (NHIF).

Contributions vary among households and formal sector employees, ensuring those with higher incomes contribute more. This model aims to prevent low-income Kenyans from being locked out of healthcare due to financial constraints while promoting equity in funding.

In a statement, the ministry affirmed its commitment to transparency and accountability in disbursing SHIF payments nationwide. It noted that SHA has prioritised faster claim processing through digital platforms, enabling real-time tracking and improving efficiency.

Despite the law prescribing a 90-day credit period for claim settlement, SHA has consistently processed and disbursed payments in under 30 days.

"This accelerated turnaround reflects the government's proactive approach to strengthening healthcare financing, reducing the financial strain on facilities, and improving the overall responsiveness of the health system," the ministry said.

However, some claims remain pending due to incomplete documentation, ongoing verification, or preauthorisation challenges.

The ministry said it is working closely with healthcare facilities to accelerate claim processing and ensure all valid payments are settled promptly.

"Hospitals facing delays are encouraged to engage with SHA for assistance in addressing submission issues and improving claim accuracy," it stated.

To enhance transparency, all claims undergo a clinical audit to confirm that preauthorised procedures were properly approved and performed before payments are processed.