Urban counties dominate SHA enrolment as ASAL regions lag behind

A clear gap in uptake of the Social Health Authority cover has emerged across the country, with urban counties recording high registration numbers while arid and semi-arid regions continue to post the lowest figures. The latest government data paints a picture of uneven participation since the introduction of the new health insurance system in October 2024.

The Social Health Insurance Fund replaced the National Health Insurance Fund and requires salaried Kenyans to contribute 2.75 per cent of their gross pay. By the end of 2025, total registered members had reached 20,997,620, according to data from the Kenya National Bureau of Statistics published in the 2026 Economic Survey.

Nairobi remains the strongest performer with 1,635,778 members, followed by Kiambu with 832,307 and Nakuru with 730,260. Mombasa stands at 704,375, while Kakamega closes the top five with 700,043 members.

Bungoma records 574,181 members, Kisumu 545,448, Machakos 509,601, Homa Bay 487,475 and Kisii 465,994, showing strong uptake in densely populated regions outside the capital.

In contrast, ASAL counties continue to show weak registration figures. Marsabit has 90,765 members, Samburu 69,027, Tana River 68,643, Lamu 66,457, while Isiolo records just 46,968 members, the lowest nationally.

The data further shows that 4,387,210 members did not indicate their county of residence during registration. Within this group, males account for 2,279,272 while females are 2,007,009.

Gender distribution overall shows women slightly ahead in enrolment, with 10,857,857 registered members representing 51.7 per cent. Men account for 9,926,987 or 47.3 per cent. A further 212,776 members did not indicate their gender, with Kakamega recording 18,366 in this category.

Among women, Nairobi leads with 844,905 members, followed by Nakuru at 387,976, Kakamega at 374,009, Mombasa at 367,563, Bungoma at 306,538, Kisumu at 286,597, Machakos at 275,475, Uasin Gishu at 217,328, Nyeri at 216,596 and Bomet at 243,659.

Male registration shows a similar urban pattern, with Nairobi at 790,221. Kiambu follows with 389,614, Mombasa at 334,118, Kakamega at 307,668, Bungoma at 264,340, Kisumu at 242,775, Machakos at 232,336 and Bomet at 218,059.