Kenya’s UHC Reforms: Progress or Repackaged Failure?
As Kenya rolls out its ambitious Universal Health Coverage (UHC) reforms, the promise of equitable healthcare for all is colliding with public skepticism, policy confusion, and echoes of past failures. While the government touts UHC as a transformative leap toward inclusive health access, many Kenyans are asking: is this truly progress, or just a repackaged version of the NHIF system that left so many behind?
Key Takeaways
UHC Reform Promise: Kenya’s Universal Health Coverage aims to provide equitable healthcare access through the Social Health Authority (SHA)
Public Skepticism: Many view UHC as potentially repeating NHIF’s structural flaws and management issues
Critical Concerns: Unclear contribution models, limited benefit clarity, and administrative opacity remain major challenges
Demonstrations: Civil society groups demand transparency, independent audits, and public participation in policy design
Success Requirements: Transparent communication, stakeholder engagement, and robust accountability mechanisms are essential
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Universal Health Coverage is designed to ensure that every Kenyan can access essential health services without financial hardship. Under the stewardship of the Social Health Authority (SHA), the new framework aims to streamline contributions, expand benefits, and reduce out-of-pocket costs.
The government’s messaging has been clear: UHC is not just a policy—it’s a moral imperative. Officials have emphasized its role in achieving Vision 2030 goals, reducing poverty, and improving national productivity. But as the rollout gains momentum, the gap between aspiration and execution is becoming harder to ignore.
Public Concerns & Criticism
For many, the UHC rollout feels eerily familiar. Critics argue that the new system mirrors the structural flaws of the National Health Insurance Fund (NHIF), which was plagued by mismanagement, corruption scandals, and inconsistent service delivery.
Major Concerns Include:
Unclear contribution models for informal sector workers
Limited benefit clarity, especially for chronic illnesses and specialized care
Administrative opacity, with little public engagement on how funds will be managed
Healthcare workers have also voiced frustration over delayed payments, understaffed facilities, and unrealistic expectations placed on frontline providers.
Demonstrations & Petitions
In recent weeks, civil society groups, professional associations, and concerned citizens have taken to the streets and online platforms to demand a more inclusive and transparent approach. Petitions circulating on social media call for:
Independent audits of SHA operations
Public participation in policy design
Safeguards against political interference and misuse of funds
These demonstrations reflect a growing sentiment: health reform must be co-created with the people it’s meant to serve.
What’s at Stake
If implemented poorly, UHC risks deepening public mistrust and exacerbating inequalities. But if done right, it could redefine Kenya’s healthcare landscape—unlocking access, improving outcomes, and restoring faith in public institutions.
The Stakes are High:
For patients: timely, affordable care
For providers: fair compensation and support
For policymakers: a legacy of reform or a repeat of failure
Understanding Kenya’s SHA & SHIF: Payment Options for Informal Workers
IMPORTANT DISCLAIMER
WE ARE NOT AFFILIATED WITH SHIF/SHA. WE ARE A PRIVATE INSURANCE COMPANY DEALING WITH VARIOUS INSURANCE PRODUCTS INCLUDING AFFORDABLE MEDICAL INSURANCE THAT CAN BE BUNDLED WITH SHA TO GIVE YOU THE BEST COVERAGE.
FOR SHA INQUIRIES, PLEASE CONTACT THE SOCIAL HEALTH AUTHORITY DIRECTLY AT THEIR TOLL-FREE NUMBER: 0800 720 601 OR EMAIL: customercare@sha.go.ke OR info@sha.go.ke.
Kenya’s journey toward Universal Health Coverage (UHC) has taken a significant turn with the establishment of the Social Health Authority (SHA) and its Social Health Insurance Fund (SHIF). As of October 2024, SHIF replaced the National Hospital Insurance Fund (NHIF), introducing a more equitable and progressive health financing system.
However, the transition has not been without challenges, especially concerning payment options for the informal sector and unemployed workers, who make up roughly 80% of the population.
This blog post delves deep into the recent policy changes, the removal of the monthly payment option, the introduction of the innovative “Lipa Pole Pole” payment plan, and what these mean for Kenya’s informal workers and the broader health system.
Key Takeaways
SHIF replaced NHIF in October 2024 with income-based contributions (2.75% of income)
Monthly payment option was removed in mid-2025 for informal/unemployed workers
“Lipa Pole Pole” plan offers flexible installment payments for annual premiums
Over 1.7 million informal households have enrolled in the new payment plan
Annual payments ensure continuous coverage and fund sustainability
Digital enrollment via *147# makes the system accessible nationwide
Choosing Medical Insurance in Kenya: A Step-by-Step Guide
I. Setting the Stage: SHA Payment Policies and the Informal Sector Reality
Kenya’s health financing landscape has historically struggled with inequities and inefficiencies. The NHIF, while a pioneer in social health insurance, relied on fixed-rate contributions that did not always reflect individuals’ ability to pay, especially for informal sector workers. The new SHIF model, under the SHA, aims to correct this by instituting income-based contributions set at 2.75% of gross income, with a minimum monthly contribution of KES 300 for the most vulnerable households.
This shift is monumental because it recognizes the diverse economic realities of Kenyans, particularly informal workers whose incomes fluctuate and are often unpredictable. However, the legal framework mandates that contributions be paid annually, a policy designed to ensure the financial sustainability of the fund and guarantee continuous healthcare coverage.
II. The Monthly Payment Option: A Temporary Lifeline and Its Removal
Recognizing the financial strain annual lump-sum payments could impose on informal workers, the SHA initially allowed a monthly payment option as a temporary relief measure. This option was a practical response to the reality that many informal workers earn daily or weekly incomes, making it difficult to save for an upfront annual premium.
However, by mid-2025, the SHA announced the removal of the monthly payment option for unemployed and informal workers, reverting to the legally mandated annual payment structure. This decision was driven by concerns over:
Fund sustainability: Monthly payments led to inconsistent revenue flows
Legal compliance: The Social Health Insurance Act requires annual payments
Administrative efficiency: Managing millions of monthly payments was operationally challenging
While this move aligns with legal and financial imperatives, it sparked widespread concern among informal workers who fear that the lump-sum payment could be unaffordable and thus limit their access to essential health services.
III. Introducing “Lipa SHA Pole Pole”: A Flexible Alternative to Annual Lump Sum Payments
To bridge the gap between legal requirements and the financial realities of informal workers, the SHA launched the “Lipa SHA Pole Pole” (pay slowly) payment plan in June 2025. This initiative is a game-changer designed to ease the burden of annual payments without compromising fund sustainability.
How “Lipa Pole Pole” Works
Installment Payments: Pay annual contributions in weekly, monthly, or daily installments
No Interest or Limits: Accessible without credit restrictions or extra charges
Digital Accessibility: Enroll and pay via USSD code *147#
Multi-sector Partnerships: Supported by government ministries, telcos, and financial institutions
Impact So Far
Since its launch, over 1.7 million informal sector households have enrolled in the “Lipa Pole Pole” plan, marking a significant milestone in expanding health insurance coverage. This approach acknowledges the irregular income patterns of informal workers and offers a practical solution to the affordability challenge.
Useful Resources on SHA/SHIF
Comprehensive Guide to SHA Packages
Understand the different SHA packages available and how to choose the best one for your needs.
IV. Balancing Legal Mandates and Financial Realities: Why Annual Payments Matter
The insistence on annual payments is not arbitrary. It is grounded in the need to:
Ensure continuous coverage: Prevents gaps in healthcare protection
Maintain fund solvency: Provides predictable cash flow for timely provider reimbursements
Reduce administrative overhead: Simplifies payment processing and management
However, the challenge lies in enforcing this requirement among informal workers who often lack stable incomes or savings. The “Lipa Pole Pole” plan is an innovative compromise that respects the law while accommodating economic realities.
V. The Broader Context: Informal Sector Workers and Healthcare Access
Informal sector workers in Kenya face numerous barriers to accessing healthcare:
Irregular income: Difficult to save for lump-sum payments
Lack of social safety nets: Limited formal employment benefits
Limited awareness: Many are unaware of SHA/SHIF benefits
Geographical and digital divides: Challenges in accessing enrollment platforms
The “Lipa Pole Pole” plan, by offering flexible payment options and leveraging mobile technology, addresses some of these barriers, but challenges remain in outreach and education.
VI. Additional Support Mechanisms and Future Directions
Recognizing that even installment payments may be difficult for some, the SHA is developing insurance premium financing options to assist vulnerable households. These are expected to provide credit facilities or subsidies to help pay annual premiums without causing financial hardship.
Moreover, the SHA has instituted a reminder system that notifies members three months and two weeks before their coverage expires, encouraging timely payments and reducing lapses in coverage.
The government is also working on:
Enhancing digital infrastructure for enrollment and tracking
Expanding partnerships with community organizations and cooperatives
Strengthening regulatory oversight to prevent fraud
VII. Concerns and Criticisms: Voices from the Ground
Despite these innovations, the removal of the monthly payment option has not been universally welcomed. Some informal workers and advocacy groups argue that:
Affordability remains a challenge: Annual premium can still be burdensome
Risk of exclusion: Some may forgo enrollment due to payment difficulties
Complexity of the system: Enrollment process can be confusing
Health facility readiness: Delays in reimbursements affect service quality
These concerns highlight the ongoing need for policy refinement and stakeholder engagement.
VIII. Conclusion: Navigating the Path to Universal Health Coverage
Kenya’s transition to the SHA and SHIF represents a bold step toward achieving Universal Health Coverage, aiming to provide equitable, affordable, and quality healthcare to all citizens. The removal of the monthly payment option for informal workers, while legally justified, posed a significant challenge to affordability and access.
The introduction of the “Lipa SHA Pole Pole” payment plan is a thoughtful and innovative response that balances legal requirements with the economic realities of Kenya’s informal sector. By allowing flexible installment payments without interest or borrowing limits, it offers a practical pathway for millions to maintain health coverage.
However, the journey is far from over. Continuous efforts are needed to improve awareness, simplify processes, support vulnerable populations, and ensure that healthcare providers receive timely payments. Only through such holistic and inclusive approaches can Kenya realize the promise of Universal Health Coverage for all its citizens.
If you are an informal worker or know someone in the informal sector, consider enrolling in the “Lipa Pole Pole” plan today via *147# and take a step toward securing your health and future.
Contact SHA Information
The Social Health Authority (SHA) in Kenya can be contacted through various channels:
