Why Kenyans feel NHIF was better than SHA

One year after the rollout of the Social Health Authority (SHA), the majority of Kenyans and healthcare providers believe the defunct National Health Insurance Fund (NHIF) offered better services.

A new survey by the Consortium of Healthcare Providers reveals that seven in ten Kenyans feel the SHA has performed worse than the NHIF. Among issues leading to loss of trust with SHA is claims issues, system failures, and financial distress that have disrupted operations in many health facilities.

The assessment, titled “Provider Assessment of the Transition to the Social Health Authority (SHA) at One Year in Kenya”, paints a grim picture of a health financing system struggling to find its footing.

According to the study, 74 per cent of healthcare facilities believe services were better under the NHIF, while only 11 per cent say delivery has improved under SHA.

“Seventy-four per cent of surveyed facilities reported that SHA was worse than NHIF, 11 per cent reported it was better, eight per cent said about the same, with the rest unsure,” the report states.

This comes despite the SHA being a key vehicle for achieving Universal Health Coverage (UHC), one of the Kenya Kwanza administration’s flagship health reforms.

By ownership, 77 per cent of private hospitals said SHA was worse than NHIF, while 76 per cent of faith-based facilities expressed similar sentiments. In contrast, 14 per cent of public hospitals said there had been no change, and 19 per cent were unsure.

The survey, conducted between September 12 and 30, 2025, covered 293 facilities: 21 public, 253 private, and 18 faith-based. Ownership of respondents was predominantly private at 86 per cent, with seven per cent public and six per cent faith-based. 

SHA rollout has been marred by technical and operational challenges. Most healthcare providers are facing severe strain due to delayed claims processing, frequent portal breakdowns, and unsettled NHIF arrears that remain pending more than a year after the transition.

At least 81 per cent of health facilities expressed dissatisfaction with SHA’s digital systems, while 92 per cent reported experiencing regular system downtimes. Claims processing remains slow and unpredictable, with only 40 per cent of facilities reporting approvals within two months.

Forty-three per cent said their claims take over three months to process, while 17 per cent were unsure when payments would arrive. The government owes hospitals—public, private, and faith-based—an estimated Sh76 billion in unpaid claims. To stay afloat, many facilities have resorted to operating on credit, taking loans, or cutting staff and services.

The survey found that 93 per cent of health facilities had delayed payments to suppliers, while 90 per cent had delayed staff salaries. Three in four facilities reported layoffs, with nurses the most affected. Nearly half of respondents said salary delays had extended beyond three months.

Financial distress has also led to partial or complete closure of some facilities. The report notes that seven per cent of hospitals—about 272 facilities—have shut down some or all of their units due to cash-flow challenges. Outpatient clinics, maternity wards, and theatres were the most affected.  To manage the crisis, 78 per cent of providers reported borrowing money to bridge SHA-related cash gaps, with more than a third taking loans exceeding Sh3 million. Over half said they have less than three months of financial runway left, and about half reported threats of auction or repossession from lenders.

The transition has also been complicated by pending arrears. About 73 per cent of facilities said the NHIF still owes them reimbursements, while 85 per cent described the settlement of these debts as critical to their survival.

Healthcare providers are now calling for reforms to stabilise the new scheme. They have urged the government to speed up claims processing, fix the unstable SHA digital portal, clear NHIF arrears, and protect indebted hospitals from auction as the transition continues.