18 million registered for SHA but only 4 million contributing, report reveals
Senators questioned how the government plans to sustain the programme with such a funding shortfall.
The Senate has raised fresh concerns over the sustainability of the government’s new health insurance programme as the Social Health Authority (SHA) struggles with a widening gap between registered beneficiaries and actual contributors.
A report tabled in the Senate revealed that while 18 million Kenyans have signed up for SHA, only four million are actively making contributions to the Social Health Insurance Fund (SHIF).
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The legislators have questioned how the government plans to sustain the programme with such a funding shortfall.
“This fund won’t become viable as the contributions are like a drop in the ocean. In the end, it will kill this fund. We need to look for ways to ensure that Kenyans make contributions to the fund. Is that sustainable? It’s a disaster waiting to happen,” Endebess MP Robert Pukose warned.
Concerns have also been raised about the heavy reliance on salaried workers in formal employment to finance the fund.
Meanwhile, enforcing contributions from the informal sector has proven difficult, with some only making payments when they need medical care and stopping once they receive treatment.
An attempt to compel non-contributors to pay by barring them from accessing government services was blocked by the courts, leaving the government with limited enforcement options.
This has further complicated efforts to ensure a steady flow of funds into the scheme.
The Senate report also pointed out that SHA lacks a clear allocation for emergency, chronic, and critical illnesses, a key component of the programme, which could undermine efforts to implement universal health coverage.
“Additionally, the Social Health Authority continues to face challenges relating to the rollout and management of SHIF, such as the processing of claims primarily associated with system failures and pending bills,” the report stated.
Safeguards
SHA anticipates raising Sh78.9 billion from contributions, but industry stakeholders have warned that without proper safeguards, the fund may collapse within a year.
Kenya Association of Private Hospitals chairperson Erick Musau cautioned the legislators that the fund is underfunded and at risk of failing.
“We do not feel that sufficient safeguards have been put up to ensure that people continuously contribute to this kitty ... if this trend goes on like this, we do not see this fund surviving beyond 12 months,” Musau said when he appeared before the National Assembly.
Health Cabinet Secretary Deborah Barasa, Medical Services Principal Secretary Harry Kimtai, Public Health Principal Secretary Mary Muthoni, and SHA Chief Executive Robert Ingasira were pressed by senators to explain the disparity between registered beneficiaries and contributors.
“You have registered 20 million but right now only four million people are able to pay the contributions. Is that right?” Kisii Senator Richard Onyonka asked.
SHA CEO Ingasira defended the numbers, saying that out of the 20.5 million registered, only about five million are required to pay, as the rest include dependants and indigent individuals whose contributions are covered by the government.
“It is not true that the entire 20.5 million people are required to pay. Out of those, we have dependants and indigents who are paid for by the government,” Ingasira explained.
The CEO also revealed that SHA is working to expand its registration, targeting school-going children in the next phase.
Despite these assurances, lawmakers criticized Ingasira for being largely absent from public discussions about the programme, questioning his visibility and role in addressing concerns.
“I am a senator and I don’t understand what you are doing. How do you expect a villager to understand what you are doing? And you are sitting there saying you have been on TV, you have never been on TV,” Onyonka remarked.
Further concerns were raised about the Ministry of Health’s control over SHA, with senators questioning whether the authority is truly independent.
“Are you (SHA CEO) the one implementing SHA or is it the ministry doing it?” Uasin Gishu Senator Jackson Mandago asked.
Narok Senator Ledama Olekina also challenged the setup. “I do not see where it is saying that it (SHA) should be domiciled under the Department of Medical Services. It is supposed to be an authority on its own.”
However, PS Kimtai defended the arrangement, stating that SHA operates under the Ministry of Health as a delegated state function.
“The creation of SHA under the SHIF Act performs the functions that are delegated, which are the functions of the State Department for Medical Services. But as an authority, they will be handling those functions as a state agency,” he said.
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