Enough PR, make SHA work

Universal healthcare was sold to Kenyans as one of the country’s most transformative social reforms. The transition from the National Health Insurance Fund (NHIF) to the Social Health Authority (SHA) promised efficiency, transparency and timely access to quality healthcare regardless of a person’s income. Nearly two years later, however, the growing reality is far removed from that promise.

The latest figures tell a troubling story.

County health facilities are owed Sh26.87 billion in outstanding SHA and former NHIF claims. The debt has more than tripled within just three months, rising from Sh8.29 billion at the end of December 2025 to nearly Sh27 billion by the end of March 2026.

Behind those figures are hospitals struggling to purchase medicines, pay suppliers, settle staff obligations and keep essential services running.

But perhaps the clearest indicator that the system is under immense strain is not found in government reports. It is found in the choices ordinary Kenyans are making.

Regulated SACCOs disbursed Sh2.2 billion in medical loans in just three months, making healthcare financing the fastest-growing category of cooperative lending.

Families are borrowing to buy medicine, pay hospital bills and, remarkably, even to finance their annual SHA contributions. That should concern every policymaker.

Health insurance exists to protect citizens from catastrophic healthcare expenses.

When insured citizens must borrow money simply to receive treatment because hospitals are unwilling or unable to honour their insurance cover, the system is failing in its most fundamental responsibility.

Government officials continue to present encouraging statistics. More than 31 million Kenyans are said to be registered under SHA.

Thousands of health facilities have been contracted. Billions of shillings have reportedly been paid out in claims since the programme’s launch.

Those numbers may well be accurate. Yet statistics alone cannot substitute for a functioning healthcare system.

Patients judge SHA by whether they receive treatment when they walk into a hospital. Hospitals judge SHA by whether legitimate claims are paid promptly. County governments judge SHA by whether reimbursements arrive on time to sustain services. By those measures, confidence is steadily eroding.

Private hospitals have repeatedly complained of delayed reimbursements. Public hospitals are accumulating unpaid claims. County governors are openly raising concerns before parliamentary committees.

Healthcare workers continue warning that delayed payments threaten service delivery.

The resignation of senior leaders within private healthcare associations following disputes over SHA implementation only reinforces the perception that relations between providers and government have become increasingly strained.

None of these developments can simply be dismissed as resistance to reform.

Every major reform experiences implementation challenges. The issue is not whether problems exist; it is whether they are acknowledged honestly and addressed urgently.

Unfortunately, the public conversation around SHA has increasingly been dominated by public relations rather than problem-solving.

Each time concerns are raised, Kenyans are presented with registration figures, payment totals and assurances that everything is working. Yet hospitals continue reporting delayed claims. Patients continue paying cash despite being registered. Counties continue reporting mounting debts. SACCO medical loans continue rising.

Public confidence cannot be restored through press conferences alone.

The government should spend less time defending SHA and more time fixing it.

The first priority must be the immediate settlement of verified outstanding claims. Healthcare facilities cannot continue operating indefinitely while waiting months for reimbursement. Delayed payments ultimately translate into medicine shortages, reduced services and higher costs passed on to patients.

Second, SHA needs a transparent claims management system that providers can trust. Hospitals should know exactly when claims are received, processed, approved or queried. Predictability is just as important as payment itself.

Third, communication with healthcare providers must improve dramatically. Reform cannot succeed if government and hospitals operate as adversaries instead of partners. Providers are not obstacles to universal healthcare; they are the very institutions responsible for delivering it.

Fourth, greater financial transparency is essential. Kenyans deserve regular public reporting not only on the total amount paid in claims but also on outstanding obligations, payment timelines, rejected claims and average reimbursement periods. Transparency builds trust far more effectively than optimistic statements.

Finally, government leaders must recognise that confidence in SHA is built in hospital wards, not media briefings.

When a mother is forced to borrow from her SACCO to admit her child despite faithfully registering under SHA, confidence declines.

When a county hospital delays treatment because reimbursements have not arrived, confidence declines. When private hospitals suspend services for insured patients, confidence declines. Those lived experiences matter more than any official presentation.

Universal healthcare remains an achievable goal. Few Kenyans question the principle behind SHA. Most support the idea that no citizen should be denied treatment because they cannot afford it.

What they question is execution.

Healthcare reforms succeed when systems become predictable, providers remain financially stable and patients receive uninterrupted care. They fail when bureaucracy overwhelms service delivery and financial obligations go unmet.

The current warning signs should not be ignored. The rise in medical borrowing, mounting unpaid claims and growing frustration among healthcare providers all point to the same conclusion: efficiency within SHA is no longer optional—it is urgent.

Kenyans are not asking for polished communication strategies or carefully crafted success narratives. They are asking for hospitals that honour their cover, providers who are paid on time and a health insurance system that works when illness strikes.

The greatest public relations victory SHA can achieve is not another media campaign or another announcement about registration numbers. It is ensuring that every legitimate claim is paid promptly, every contracted hospital remains operational and every Kenyan can walk into a health facility confident that their insurance card is worth more than the plastic it is printed on.