Counties across Kenya continue to experience large differences in Primary Healthcare (PHC) funding, raising concerns about access to basic health services and the timely use of allocated resources.
Between October 2024 and January 2026, the Social Health Insurance Fund (SHA) released sh7.2 billion to counties, with Nairobi receiving the largest share at Sh649.7 million, followed by Kakamega with Sh356.7 million and Bungoma at Sh286.3 million.
In contrast, counties such as Isiolo, Samburu, and Tana River received the smallest allocations, highlighting persistent gaps in equitable distribution.
The SHA has called for an urgent release of Sh5.9 billion from the national treasury to settle PHC claims up to December 2025.
“Settlement rate=Paid amount/Actual received amount. Actual received amount=Total received-Rejections-Sentbacks,” the agency stated, underscoring challenges in clearing funds efficiently.
Review of submitted claims shows that some were rejected due to incomplete documents, falsified information, upcoding, or double-dipping of benefits. Certain facilities also filed claims for services outside their approved scope.
Despite these issues, SHA reported progress in compliance: “A number of hospitals consistently submitted complete and properly signed medical reports, forms, and invoices. Most providers strictly adhered to SHA’s tariffs and benefit package limits, ensuring members were not overcharged. Many facilities observed the timelines for claims submission, allowing quicker reviews and processing.”
PHC allocations support essential programs including free maternity services. From October 2024 to December 2025, Kenya recorded 583,298 normal deliveries and 326,684 Caesarean sections, requiring about Sh2,046,130,500 for Level II and III government and faith-based facilities.
Funds also cover services for teen mothers and emergency cases, though only 15 percent of initial emergency claims were eligible due to misuse. The fund is set to expand coverage to 1,070 Level 4A to Level 6 facilities, with an annual budget of Sh500 million.
The Facility Improvement Financing (FIF) initiative, designed to give hospitals financial independence, is not yet fully functional. Counties have often used FIF revenues to replace budget allocations instead of supplementing them. SHA emphasizes that retained revenue should “supplement, not substitute, county budgets to improve quality of care.”
Further challenges include pending NHIF bills amounting to Sh33.5 billion, with 5,454 facilities holding claims below Sh10 million.
Of these, 2,972 are government facilities scheduled for desktop verification to speed up payment. Over 1,287 facilities have not received PHC funds due to mismatched bank accounts or incomplete e-contracting procedures.
To address these issues, SHA has intensified county engagement. Meetings have been held in Kisii, Kisumu, Mombasa, Mandera, Embu, and Makueni to support smooth fund implementation. Training for all Level 4 to 6 health facilities will take place from February 12 to 20, 2026.
The SHA claims office is now fully staffed to improve review and pre-authorization processes. Civil servants and TSC teachers are being enrolled under the POMSF scheme, with counties encouraged to create special wards and improve service quality for all beneficiaries.
