The politics of SHA a year later: Health sector reform or rhetoric?

The attempted theft of Sh10 billion by unscrupulous hospitals, coupled with allegations of system failures and resistance from sections of the political class, has cast a shadow over the programme.

The controversies have triggered debate on whether SHA is a genuine health sector reform or just political rhetoric by the current administration.

Kenya National Union of Nurses secretary general Seth Panyako has raised concerns about the sustainability of SHA, accusing the government of rolling it out haphazardly without involving key stakeholders.

According to the unionist, while the government is keen on registering 50 million Kenyans, only a fraction are actual contributors.

“This programme will collapse. There is no way four million workers can sustain 50 million people,” he warned.

Panyako argued that Kenyans with pay slips shoulder the heaviest burden after the government revised contributions to 2.75 per cent of their income.

Meanwhile, most Kenyans in the informal sector only pay premiums when they or their relatives are sick, rendering the scheme financially unstable.

“SHA should be social protection where those who are healthy support those who are sick. But people have discovered that when you’re not sick, you don’t have to pay,” he said.

Kenya Union of Clinical Officers secretary general George Gibore, however, defended SHA, noting it has eased access to healthcare for millions.

“SHA has registered over 25 million people. Anyone registered can now receive services in sub-county hospitals without paying. That never happened with NHIF,” Gibore said, citing the inclusion of chronic illness coverage and anti-fraud systems as major gains.

Gibore, however, emphasised the need to fight graft dogging the new programme, shorten the time for payment of claims and seal loopholes in the system to curb fraud.

Launched on October 1 last year, SHA—also branded as Taifa Care—was billed as a flagship step toward achieving the long-elusive Universal Health Coverage.

It replaced the scandal-ridden National Health Insurance Fund (NHIF), which for decades had been dogged by mismanagement and graft.

 “Unlike NHIF, which covered only those who could afford it or had formal jobs, SHA is for all Kenyans,” President William Ruto recently said.

SHA oversees three key funds: the Social Health Insurance Fund, the Emergency, Chronic and Critical Illness Fund, and the Primary Healthcare Fund.

25 MILLION

According to the government, at least 25 million people have registered under SHA, guaranteeing access to free outpatient services at dispensaries, health centres, and Level 1–4 hospitals.

“We have Taifa Care, and I want to urge women to register. Your job is just to register with SHA. When you go for treatment at a dispensary, health centre or sub-county hospital for outpatient services, you will be treated and given medicine without paying a coin,” Ruto said.

Kenya Kwanza leaders, led by Health CS Aden Duale and Members of Parliament, see it as a game-changer in health provision and a watertight system.

“NHIF was a den of corruption. That is why we shut it down. We must verify every shilling before payment,” he added.

National Assembly Majority Leader Kimani Ichung’wa dismissed SHA critics as naysayers and urged Kenyans yet to register with the programme to do so for uninterrupted access to health services.

“We urge Kenyans to ignore the misinformation being peddled by some leaders and register in large numbers to benefit from this initiative,” Ichung’wa stated. Ichung’wa called on politicians to advocate for SHA, urging them to educate the public on its benefits.

PAST CORRUPTION

He accused critics of being sympathisers of past corruption at KEMSA, where public funds were allegedly embezzled through procurement scandals.

But as the government makes a case for the programme in its first year, SHA is mounting challenges that have cast doubt about its efficiency, credibility and ability to safeguard public funds.

Recently, SHA, through the ministry, exposed an attempted theft of billions of shillings through fictitious claims. There are also claims that SHA disbursed money to non-existent hospitals.

Already, a section of MPs has threatened to impeach Duale for presiding over a collapsing health sector, arguing that Kenyans continue to suffer amid the government’s efforts to streamline the country’s health system.

They spoke amid mounting claims of fraud within SHA, including payments to ghost facilities and fictitious claims.

“We have the signatures ready. When Parliament resumes, a motion will be tabled. Duale must take political responsibility for the theft of taxpayers’ money at SHA,” declared Nairobi Senator Edwin Sifuna.

Other lawmakers echoed the calls, warning that the health crisis was directly endangering lives.

“As you play your political games, 156 children are being born every hour—and many risk dying due to the crumbling health system,” Githunguri MP Gathoni Wamuchomba said.

Duale has defended his actions, insisting the decision to suspend payments was necessary to combat widespread fraud. He said the attempted fraud was flagged by the system. He has, in turn, accused some MPs of being complicit in schemes to siphon funds from the authority.

“We have a watertight and solid system. You cannot steal even a Panadol from a health facility under the SHA. We are ready and willing to answer any question because accountability is at the core of this system,” he said.

IMPLICATED IN FRAUD

The President has vowed that any hospital implicated in the fraud will be compelled to pay back the money they might have received and their managers prosecuted.

“We are telling those who think the theft they were doing at the National Hospital Insurance Fund can be replicated at SHIF that they are daydreaming.

“Any hospital, whether public, private, or faith-based, if they have stolen NHIF money, they will pay that money. If they have brought corruption to SHIF, they will pay back that money, and we will prosecute them,” he said.

As politics and claims of fraud rock SHA, patients report being turned away or asked to pay out of pocket due to system downtime, while collusion between some health facilities and patients has further strained credibility.

Allegations of corruption through fictitious hospitals, inflated claims, and denial of payments for certain ailments have tainted the scheme.

“There is massive corruption at SHA. Billions are being allocated to ghost hospitals, yet mission hospitals receive nothing. Who is fooling whom?” former Deputy President Rigathi Gachagua said, describing the system as a grand scam.

Gachagua alleged that senior government officials are at the centre of the scheme, channelling funds to nonexistent hospitals while mission facilities remain unpaid.

The authority also grapples with underfunding, creating financial strain on providers. A problematic digital portal has compounded delays in registration and claims processing.

Parliament has questioned the programme’s sustainability. In March, the Senate Finance and Budget Committee flagged that while 18 million Kenyans had registered, only four million were actively contributing.

“This will affect the funding trend for the fund and may occasion shortfalls in contributions,” the committee warned.

Heavy reliance on salaried workers has sparked discontent, with many decrying steep deductions from their pay slips. Enforcing contributions from the informal sector remains elusive.

An initial proposal to deny non-contributors access to government services was blocked in court, leaving room for many Kenyans to pay only when sick and withdraw afterwards.

“This fund won’t become viable as the contributions are like a drop in the ocean. In the end, it will kill this fund,” Endebess MP Robert Pukose cautioned. We need to look for ways to ensure that Kenyans make consistent contributions. Is that sustainable? It’s a disaster waiting to happen,” he added.

However, according to the SHA management, not everyone registered is required to pay the premiums.

“It is not true that the entire 25 million people are required to pay. Out of those, we have dependants and indigents (those unable to pay) who are paid for by the government,” he said.

The Social Health Authority is established under section 25 of the Act and is utilised to pool all contributions made under the Act.

SHA is designed to provide healthcare services from empanelled and contracted healthcare providers and healthcare facilities on referral from primary health facilities.

SHA ensures that every resident in Kenya can access a comprehensive range of quality health services.