A small fraction of Kenyans enrolled in the Social Health Authority are contributing to the scheme, raising concerns that the country’s healthcare financing system may face serious strain.
Out of nearly 29 million registered, only about five million are actively remitting premiums, prompting lawmakers to caution that weak participation could undermine ongoing reforms.
The National Assembly’s Departmental Committee on Health, led by Seme MP James Nyikal, highlighted the problem during discussions in Mombasa with Medical Services Principal Secretary Ouma Oluga and Social Health Authority officials. Nyikal said the authority is struggling to raise enough funds to cover its obligations across all three of its insurance schemes.
“The revenue that the Social Health Authority collects for the three funds is really not enough to meet its expenses. As things stand now, they are barely getting what they need to run,” he said.
He pointed out that contributions from formal sector workers, who pay through their employers, remain steady, but the bulk of expected revenue from the informal sector is not coming in.
“Those in formal employment remit their contributions directly through employers, and that has remained the main source of income. But we expect a larger portion to come from the informal sector, and this is where the challenge lies,” Nyikal said.
The discrepancy between registration and active payments, he warned, could weaken the authority’s ability to provide consistent healthcare services if not addressed urgently. To boost collections, the Social Health Authority is considering partnerships with savings groups, SACCOs, and microfinance institutions to enable informal workers to pay smaller amounts over time.
Nyikal also stressed the role of the Primary Health Care Fund, which is supported by the government and finances services at lower-tier facilities. Strengthening this fund, he said, would help reduce pressure on hospitals handling more complex cases.
“This fund is extremely important because it caters for services at Level Two, Level Three and outpatient care in higher facilities. If we strengthen it, we reduce pressure on higher-level hospitals,” he said.
Parliament has increased funding for the scheme, raising allocations from Sh8 billion to Sh13 billion last year, with another Sh2 billion suggested in the current supplementary budget.
Lawmakers are also concerned about adverse selection, where people only join the scheme or make payments when they fall ill. Nyikal noted that the current benefits package remains insufficient, not fully covering healthcare costs or patient needs.
The committee plans to push for Sh5.3 billion to settle legacy claims under Sh10 million from the defunct National Hospital Insurance Fund. Nyikal warned that unresolved debts have already disrupted services, with some facilities scaling down operations or closing entirely.
“Many facilities have closed or scaled down operations because of these debts. We will recommend that this money be made available so providers can be paid,” he said.
Delays and disputes in claims processing have been another challenge, but Nyikal said improvements are being implemented through new digital systems.
He emphasized that the success of the Social Health Authority depends not only on its design but also on effective implementation and public confidence.
“The design and concept are good. The problem we are going through is one of implementation. It requires cooperation from management, providers and the public,” he said.
The committee is also reviewing the proposed Patient Safety Bill, which aims to separate the regulation of healthcare workers from that of health facilities. Nyikal described the process as complex, requiring further refinement.
Legislators are simultaneously considering a Harm Reduction Bill to support people struggling with drug addiction, a move seen as part of broader efforts to strengthen public health services.