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.

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.

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.

Contact SHA Information

The Social Health Authority (SHA) in Kenya can be contacted through various channels:

• Toll-free number: 0800 720 601
• Email: customercare@sha.go.ke or info@sha.go.ke
• Official website: sha.go.ke

SHA Branch Locations