Counties in Kenya continue to show stark differences in insurance access, with Nairobi and Kiambu at the forefront while several regions struggle to secure even basic coverage.
A recent Financial Sector Deepening (FSD) survey highlights how economic status, employment type, and education shape the ability of households to obtain insurance, revealing the country’s persistent financial divides.
The survey shows that 12 percent of Nairobi and Kiambu residents reported having at least one insurance policy in their name last year, not including social health coverage. Murang’a followed at 11.3 percent, Nyeri at 10 percent, and Kirinyaga at 9.5 percent.
At the lower end, Kisumu recorded 1.1 percent, Siaya 1.2 percent, and Meru 1.3 percent. According to the report, counties with higher formal employment, active businesses, educated populations, and diversified household incomes are more able to access insurance, while those relying heavily on informal work and with limited financial services fall behind.
These disparities leave millions of families in vulnerable counties exposed to health emergencies, accidents, crop or livestock losses, and natural disasters—events that often deepen poverty. Globally, insurance coverage is considered a marker of financial development and stability.
Higher uptake usually indicates greater financial literacy, disposable income, and stable livelihoods, conditions most common in urban and peri-urban regions.
“By 2024, exclusion from insurance (excluding NHIF) remains highest among casual workers, dependents and agricultural livelihoods, suggesting that informal employment and financial vulnerability limit access,” the survey notes. “Those employed and business owners show relatively lower rates of exclusion. Those who are not financially healthy and in lower wealth quintiles consistently report high levels of insurance exclusion, while improvements are seen among financially healthier and wealthier individuals. The data underscores a persistent socio-economic divide in usage of insurance services.”
Kenya National Bureau of Statistics data shows Nairobi contributes 27.4 percent of the national economy, followed by Nakuru at 5.7 percent, Kiambu at 5.5 percent, Mombasa at 4.8 percent, Meru at 3.5 percent, and Machakos at 3.2 percent.
The FSD survey was conducted as the country prepared to transition from the National Health Insurance Fund (NHIF) to the Social Health Insurance Fund (SHIF).
Results show that insurance access excluding NHIF declined from 6.9 percent in 2021 to 6.3 percent in 2024, while access including NHIF fell from 23.7 percent to 22 percent.
At the same time, overall usage—including coverage through a family member or employer—rose from 11.4 percent to 13.7 percent for insurance excluding NHIF, and from 28.2 percent to 29.5 percent for all insurance including NHIF, showing that many still benefit indirectly from policies.
“Overall trends show sustained disparities in access by residence, gender, age, and education level. These trends highlight growing inequalities and underline the need for inclusive reforms in Kenya’s insurance landscape,” the survey added.
Affordability emerged as the top barrier, with 76.2 percent of uninsured Kenyans citing cost as the main reason. Women were slightly more affected at 77.3 percent, compared to 74.7 percent of men. Lack of knowledge about insurance followed at 23.4 percent, particularly in rural areas (27.8 percent) compared to urban areas (15.5 percent). Other factors included missing national identification cards (8.4 percent), belief that insurance is unnecessary (7.4 percent), and lack of trust in providers (1.6 percent).
Among people who had insurance but later dropped it, 61.4 percent said they could no longer afford the premiums, and 41.9 percent cited job or income loss.
Among business owners who stopped coverage, 65.5 percent said cost was the main reason. The survey emphasizes how vulnerable insurance uptake is to economic shocks in a largely informal workforce with unstable income.
Education is also a strong predictor of insurance access. Kenyans with tertiary education recorded 18.9 percent access to insurance excluding NHIF, compared to just 1 percent for those without formal education.
“The survey revealed that access to insurance excluding NHIF, varied by education level, reinforcing the findings that a lack of understanding contributes to low uptake among those without insurance in their own name,” it said.
