SHA Reports Sh131 Billion Paid Out

The Social Health Authority (SHA) has announced a significant increase in funds flowing into the health sector, with Sh131 billion paid out since October 2024.

This is a major improvement compared to the former National Health Insurance Fund (NHIF), which at its peak disbursed around Sh60 billion.

SHA says the increase has had a direct impact on citizens, with eight million Kenyans accessing primary healthcare services without paying out of pocket.

Additionally, three million people have used Social Health Insurance Fund (SHIF) services, representing more than a 50% rise in service usage compared to NHIF.

A key factor in this improvement is SHA’s new centralized digital platform, the SHA ICD system. The system has already flagged and rejected Sh11 billion in fraudulent or non-compliant claims.

SHA CEO Dr. Mercy Mwangangi emphasized that these funds were not lost but protected from potential misuse through the platform’s strong checks and controls.

The transition from NHIF to SHA has been complex, involving the winding up of the former fund. SHA inherited Sh33 billion in pending claims and is verifying all inherited assets, including land and equipment, with the help of the Ministry of Public Works.

Staffing has been streamlined from 1,700 NHIF employees to 815 under SHA, with the full transition expected by the end of March.

SHA has also introduced a new Sh500,000 package for Kenyans seeking treatment abroad. The authority is finalizing contracts with hospitals globally, moving beyond the traditional reliance on Indian hospitals.

Hospitals will need local agents to handle referrals, with the new arrangements expected to be in place by the end of February. Until then, SHA cannot legally pay for treatment at uncontracted facilities, leaving some patients abroad to cover their own medical bills.

Parliamentary oversight has highlighted historical irregularities under NHIF, including lost assets, overpayments, and irregular contract awards.

In one case, 16 desktop computers went missing while being transported by a driver, who was later discharged by the court.

Auditors also flagged Sh38.8 million paid to a law firm, which SHA defended as a negotiated fee in a complex constitutional case. Other irregular contracts totaling Sh2.8 billion were found to have had unverified certificates at the time of award.

Despite these challenges, Dr. Mwangangi reassured Kenyans about the safety of their contributions. “SHA is indeed working… your funds are protected,” she said, urging those who are not yet registered to join. “SHA can protect you and ensure you get good health.”