IMPLEMENTATION CHALLENGES OF THE SOCIAL HEALTH INSURANCE FUND (SHIF) AND THEIR IMPLICATIONS FOR UNIVERSAL HEALTH COVERAGE IN KENYA

Abstract

Kenya abolished the long-serving National Health Insurance Fund (NHIF) and introduced the Social Health Insurance Fund (SHIF), administered by the Social Health Authority (SHA), to close coverage gaps, improve pooling, and accelerate Universal Health Coverage (UHC) under the Bottom-Up Economic Transformation Agenda (BETA). However, emerging evidence from the 2024–2025 transition period suggests registration difficulties, contribution compliance risks, provider confusion, and fiscal/ICT readiness gaps that may undermine the reform’s intent. This study sought to examine the implementation challenges of SHIF and to determine their implications for access, financial risk protection, and service quality in Kenya. A descriptive, mixed-methods design drawing on key informant interviews with Ministry of Health and county officials, plus a survey of accredited facilities, was proposed. Findings (hypothetical, based on current public reports) indicate that unclear beneficiary onboarding, fragmented digital infrastructure, and delayed provider reimbursements threaten continuity of care, especially for poor and informal-sector households. The study concludes that SHIF, in its current rollout configuration, risks reproducing NHIF’s inequities if governance, communication, and provider-payment systems are not stabilized. It recommends phased implementation, differentiated contribution mechanisms for informal workers, and a single national health client registry fully integrated with SHA systems.

Keywords: Social Health Insurance Fund, Social Health Authority, Universal Health Coverage, health financing, Kenya.