County hospitals across Kenya are facing mounting financial pressure as unpaid claims by the Social Health Authority (SHA) rose to nearly Sh27 billion by the end of March 2026, according to a report by the Controller of Budget (CoB).
The report shows the outstanding claims more than tripled within three months, raising fresh concerns over the authority’s ability to reimburse health facilities despite repeated assurances from the government that the system is working smoothly.
According to CoB Margaret Nyakango, county health facilities were owed Sh26.87 billion by SHA as of March 31, compared with Sh8.29 billion recorded at the end of December 2025.
The growing debt has placed health facilities under strain, with some facing challenges in maintaining services due to delayed payments.
Nakuru County has the highest outstanding claims, with health facilities owed Sh2.81 billion through the Facility Improvement Fund. Of this amount, Sh2.4 billion is owed by SHIF, while Sh432.9 million relates to the former NHIF.
Kakamega County follows with outstanding claims of Sh1.3 billion, including Sh241.4 million owed by the former NHIF.
Other counties with large pending claims include Nyeri, which is owed Sh632 million by SHIF, and Mombasa, which has pending payments of Sh596.7 million. SHIF accounts for Sh357.1 million of Mombasa’s debt, while Sh239.6 million is linked to NHIF.
Kiambu County is owed Sh474.8 million by SHIF, Garissa Sh429.48 million by both SHIF and NHIF, and Bomet Sh421.69 million, with NHIF accounting for Sh54.2 million.
Homa Bay County has pending claims amounting to Sh390.3 million, Bungoma Sh358.5 million, Kajiado Sh343.8 million, Kitui Sh333 million, Siaya Sh287.47 million and Kisumu Sh282.39 million.
Other affected counties include Elgeyo Marakwet, which is owed Sh197.86 million, Migori Sh185.4 million, Nyandarua Sh183 million, Tharaka-Nithi Sh173.1 million, Kericho Sh165.7 million, Embu Sh163.74 million, Busia Sh134.8 million and Kwale Sh127.3 million.
Baringo has pending claims of Sh98.3 million, Marsabit Sh85 million, Machakos Sh68.25 million, Narok Sh67.4 million and Samburu Sh4 million.
The Controller of Budget also noted that 19 counties failed to submit their data on outstanding claims. They include Nairobi, Taita Taveta, Nyamira, Nandi, Murang’a, Meru, Mandera, Makueni, Isiolo, Kilifi, Kirinyaga, Laikipia, Lamu, Tana River, Trans Nzoia, Uasin Gishu, Vihiga, Wajir and West Pokot.
The situation comes despite the government’s continued defence of SHA, which was introduced in October 2024 as a new healthcare financing model meant to guarantee affordable and accessible medical services for all Kenyans.
SHA replaced the National Health Insurance Fund (NHIF) through the establishment of the Social Health Insurance Fund (SHIF).
Speaking on June 13, Interior Principal Secretary Raymond Omollo said more than 31 million Kenyans had registered under SHA, with 11,034 health facilities contracted to provide services under the programme.
He said SHA had paid more than Sh147 billion in claims since its launch in October 2024 to support healthcare access across the country.
However, only about 4.8 million Kenyans have been contributing to the authority, with four million being salaried workers and 890,000 from the informal sector. The contributions have generated Sh70 billion.
Health sector organisations have criticised SHA over delayed payments and governance concerns.
The Kenya Medical Practitioners and Dentists Union and the Rural Private Health Association said the authority had failed Kenyans due to unpaid claims. They said that by August 2025, SHA had paid about Sh53 billion against claims amounting to Sh96.2 billion.
Appearing before the Senate County Public Accounts Committee on June 16, Homa Bay Governor Gladys Wanga said her administration was owed about Sh350 million by SHA.
She told the committee, chaired by Homa Bay Senator Moses Kajwang, that while SHA reimbursements had improved compared with the previous NHIF system, there was a need for faster payment of claims to ensure health services continue without interruptions.
“Every treatment you make, you file the claim, but the money doesn’t necessarily come back to you on time. SHA owes us approximately Sh350 million for the health facilities in Homa Bay,” Wanga said.
Nairobi Senator Edwin Sifuna said the situation showed that there were challenges within SHA despite Kenyans having contributed Sh104 billion towards supporting the authority’s operations.
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