SHA enrollment hits 32.2 million but only 5 million pay premiums

President William Ruto and Health Cabinet Secretary Aden Duale have celebrated the 32.2 million enrollment under the Social Health Authority (SHA), describing the figure as the highest number of Kenyans ever enrolled in a health insurance scheme.

But the high registration numbers mask a much smaller pool of people actually contributing to the scheme, with an insider familiar with SHA operations saying only about five million members are remitting premiums.

“The question is not about the number of people registered to the scheme, but how much is being collected,” said the insider, who requested anonymity for fear of victimisation.

“Registration is one thing. Contribution and retention are a different thing.”

• Hospitals crisis drags on as Duale, Clinical Officers clash over pay deal
• Union supports crackdown on foreign medical practitioners
• Duale pushes digital health rollout to improve patient care
• SHA denies jobs bias as ex-NHIF staff wait for deployment

During the launch of a national ambulance dispatch centre held on Wednesday last week, Health CS Duale noted that 32.2 million Kenyans are SHA registered members, with Mombasa leading in registration, having achieved an 80 per cent registration rate.

Duale said Sh170 billion in hospital claims had been paid.

Though President Ruto did not give details on contributions, he maintained that the data is important.

“Science is important. If you have no data, you operate on guesswork and are sure to fail,” said Ruto.

Of the registered numbers, only about 5 million are remitting their premiums, among them 3.7 million in the formal sector, and 1.7 million in the informal sector.

Under the defunct National Health Insurance Fund (NHIF) at least 7.9 million households were registered, including 3.7 million in the formal sector.

About 1.6 million were also onboarded to the Fund, under government sponsorship programme namely orphans, widows, indigents, and Universal Health Coverage (UHC) programme.

This cluster of people had their premiums paid for by the exchequer, whereas others in informal sector were remitting their monthly Sh500 premiums.

The registered people, according to the insider were adults, able to pay premiums, unlike in SHA, where the 32.2 million represents individuals able to pay premiums, including their dependants like children.

“SHA has more people registered, but they include even children. Under NHIF, the numbers were about 22 million,” said the insider.

Currently, the government has registered less than 300,000 indigents including the poor, orphans and widows, whose premiums are fully paid for by the government.

Their premiums are fully paid by the government.

Less than one million people in the informal sector are remitting their annual premiums.

Because of low remittance of premiums, SHA’s membership and contribution report of March, shows the authority collects only about Sh90 billion annually, a collection that is way below its expenditure.

The collection is slightly Sh10 billion more, compared to Sh80 billion that defunct NHIF used to collect annually, for all premiums, including payments from the informal sector, formal and all sponsored for programmes.

According to SHA membership and contribution analysis report, which The Standard has a copy, for 15 months between October 2024 and December 2025, a total of Sh96.5 billion was collected.

Of the contributions, Sh90 billion was formal contributions, Sh6.1 billion informal contributions, and Sh193,825,675 sponsored contributions.

By then, a total of 4.4 million were contributing premiums to the scheme.

Of the numbers, 3.2 million were formal membership, and 1.06 million informal membership.

The number of sponsored memberships stood at 294,583, whose premiums of Sh193,825,675 was paid for by the exchequer, and other sponsors.

Loss ratios incurred at the authority was also high.

For instance, in 2024/25, the authority, through one of its funds-SHIF raised claims worth Sh77.9 billion, against revenue pool of Sh55 billion, capturing a Sh25.4 billion deficit in financing.

This was after a further Sh2.7 billion in administration cost.

On the premiums collected, the insider explained that all medical insurances use the loss ratio as a measure of financial sustainability.

The insider who requested anonymity for fear of victimisation, said SHA has high loss ratio, of beyond 95 per cent, against 85 per cent under defunct NHIF.

Additionally, the source explained that threshold cannot go beyond 95 per cent as per the law.  This entails at least 95 percent for medical claims, and 5 percent for administration cost.

SHA has overall claim ratio of 126 per cent, and 119 per cent above the legal threshold.

If applied per fund, according to the SHA membership and contribution analysis report, only ECCF was sustainable in the first year of rollout.

ECCF received an allocation of Sh5.4 billion, and of the allocation, Sh1.1 billion was paid for claims, and Sh2 billion used for administrative and operating expenses.

“Beyond 95 percent, the authority is running at a loss. That is why providers are complaining they have not been paid. The bills are just more than revenue,” he explained.

“Threshold means the expenditure charged on claims should not go beyond 85 per cent. If it does, the fund will be at risk of not being able to pay claims,” explained the insider.

Compared to NHIF which maintained a medical loss ratios of less than 85 per cent, the legal provisions give the authority a threshold of 95 per cent beyond which, the fund would be financially unstable.

According to the source, if SHA was operating under the same legal conditions as private insurance, the Insurance Regulatory Authority (IRA) would be required to declare it technically insolvent and place it under a statutory manager.

“NHIF was using 85 percent as the threshold. Anytime it went beyond that, management decisions would be required to control costs,” added the insider.

Unlike individuals in the formal sector whose premiums are capped at 2.75 percent of their earnings, contributions that are statutory, those in the informal sector undergo means testing to determine how much to remit to the social scheme.

“Registration is not a problem, but how many are making contributions,” said the insider.

“From interactions, people in the informal sector are not comfortable with means testing, because it generates premiums that they cannot afford,” added the source.

Additionally, he hinted that there is an extremely poor cohort, and food poor who can also not afford premiums.

Food poor, he explained would earn some income, but their priority is food, rather than health cover, because the earning is not adequate to afford both.

Data shows poor Kenyans and those without dependable income has increased.

The individuals are however able to access services at dispensaries and health centers, and emergency care, as such is catered for, by the exchequer.

In Level 4, and 5, they must pay for care, as the facilities require Social Health Insurance Fund (SHIF),

“We are reporting adverse selection in remittance of SHA premiums, where people only pay when sick. I have not witnessed many changes,” observed the insider. “This is the same to what was happening at NHIF”.

Experts have poked the remittance to SHA, saying there is need to look into contributions to sustain the social scheme, and guarantee quality care among Kenyans.

Prof XN Iraki, an economist and a lecturer at the University of Nairobi, told The Standard that there is a problem with onboarding of Kenyans to SHA.

“Contribution is the problem. We only contribute when sick. After that we stop. I keep wondering why we give the number registered, not contributing,” posed Iraki.

To have Kenyans in the informal sector remitting premiums to SHIF, he said there is need to have the Government address the issue of unemployment.

“Give them jobs and livelihoods. The rich easily pay for insurance without any prodding. Poor fail to pay for SHA because they have no money,” said Iraki.

“Do we buy food, pay rent or school fees or pay for SHA?” added the economist.

“Registration does not equal contributions. Only 5 million registered members are contributing to SHA. The Greatest hindrance is purchasing power due to hard Economic times,” said health economist and public policy expert Beatrice Kairu.

Kenya’s economy, she said is highly informal and the informal sector there is inconsistency in incomes.

“The SHA design anticipated the informal sector to come on board but that is not the case. The people bearing the burden are the people in the formal sector,” added the expert.