How SHA payment policy has locked out poor patients

Taita Taveta Senator Johnes Mwaruma in Parliament, on March 17, 2025. [Boniface Okendo, Standard]

Senators have criticised the Social Health Authority (SHA) over claims that patients are required to contribute for a full year before they can access medical care.

The lawmakers, who were contributing to a statement sought by Taita Taveta Senator Johnes Mwaruma, expressed concern that many Kenyans are being denied health services despite having made contributions, simply because they have not completed 12 months of payments.

“This situation undermines the fundamental rights enshrined in Article 43(1)(a) and Article 43(2) of the Constitution of Kenya, 2010, which guarantee every person the right to the highest attainable standard of health, including access to health care services,” said Mwaruma.

The senator requested a statement from the Senate Health Committee explaining the rationale behind the policy that denies medical services to contributors who have not yet completed a full year of payments—even in cases where contributions are up to date at the time of seeking treatment.

Mwaruma also asked whether data from the now-defunct National Hospital Insurance Fund (NHIF), including contributor identities and payment histories, had been successfully migrated to the SHA system.

According to Senate Majority Leader Aaron Cheruiyot, there was lack of clear communication on how payments should be made to qualify for one services.

“There is an assumption that everyone understands English and Kiswahili. Yet we live in a country where many elderly citizens did not have the opportunity to attend school, but they too deserve access to this information,” said Cheruiyot.

Busia Senator Okiya Omtatah criticised the SHA’s implementation, alleging that the Social Health Insurance Fund (SHIF) serves as a tool to exploit the poor. He argued that if the government were committed to universal health care, it would begin by properly equipping public hospitals.

“We are forcing people—who might otherwise have benefited from cover—to pay annually, even when they lack the financial capacity. They should be allowed to contribute according to their means if they are to benefit from the State’s healthcare scheme. As it stands, SHIF is simply a mechanism of extraction,” he said.

Nominated Senator Karen Nyamu acknowledged that SHA was a bold step toward achieving universal health coverage, but said the requirement for beneficiaries to complete a full year’s contribution before accessing services is discriminatory.

“What happens to a mama mboga who falls ill just one month into her contributions? What about a boda boda rider injured in an accident after only three months of payments? We are exposing the very people we claim to protect under universal health care to the worst-case outcomes, including death,” Nyamu said.

Nyandarua Senator John Methu echoed the call for reform, questioning the logic of the current payment structure.

“We have comprehensive medical cover. And because we enjoy this privilege, many MPs are out of touch with the pain and suffering ordinary Kenyans face,” said Methu.