More than 32 million Kenyans are now registered with the Social Health Authority (SHA), which has collected Sh203.7 billion and released Sh178.4 billion to healthcare providers in the 19 months since the new health financing system came into operation.
The latest figures show the scale of funds flowing through the four SHA-managed funds, with the Social Health Insurance Fund (SHIF) accounting for the largest share of collections and payments to healthcare facilities.
SHIF, which is funded through monthly contributions from Kenyans, has brought in Sh151 billion since it was introduced in October 2024. Of this amount, Sh134.7 billion has been paid to healthcare providers.
SHA chief executive officer Mercy Mwangangi said the fund can only provide benefits to Kenyans if they take part by making their required contributions.
"SHIF will succeed in this country if we all contribute and put money into it. If you are not contributing, then you do not benefit. This is the design of this fund," Mwangangi said.
The Primary Health Care (PHC) Fund has received Sh27 billion from the Treasury and paid Sh23 billion to healthcare providers.
The allocation is higher than the Sh1.8 billion that had been provided under the previous government, with SHA saying the increased funding is helping expand access to services at lower-level health facilities.
Mwangangi said primary healthcare remains important because it allows a large number of Kenyans to receive treatment before their conditions become more serious.
"A country that invests in PHC is investing in 70 per cent of disease burden. The PHC investment is a goal for Kenyans because it means for every registered Kenyan under SHA, 32.2 million Kenyans can walk in and out and get treatment," said SHA chief executive officer Dr Mercy Mwangangi.
The Emergency, Chronic, and Illness Fund has collected Sh8 billion during the period and paid Sh3.5 billion to providers.
The Public Officers and Police Officers Fund, meanwhile, has received Sh17.2 billion and paid out Sh16.9 billion.
Private hospitals have also benefited from the health financing system, receiving more than Sh20 billion from SHA.
The authority has reported a wide range of services that have been funded through SHIF, including maternity care, hospital admissions, operations, cancer treatment, dialysis and mental health services.
About 1.2 million safe deliveries have been supported through free delivery services at primary healthcare facilities.
Teenage mothers are also able to receive the service once they obtain a temporary identification document, allowing them to access care through the scheme.
The fund has financed more than one million inpatient admissions. Among those treated are 19,444 patients who required critical care and 7,000 people who received mental health admissions.
Another 469,000 surgical procedures have been supported through the fund.
Cancer treatment is also covered, with more than 48,000 patients currently accessing services through SHIF. The government has raised the amount available for oncology treatment from Sh550,000 to Sh800,000.
Dialysis services have been accessed by about 16,800 patients. Most of these are chronic patients who need two dialysis sessions every week.
The overseas treatment benefit has also returned under the scheme. The benefit is capped at Sh500,000 for every eligible patient, with nine international facilities contracted to provide the service.
So far, one patient has been referred abroad under the arrangement.
SHA has also expanded its primary healthcare programme across the country, with Mwangangi saying all counties now have access to free primary healthcare services.
More than 10 million Kenyans have received treatment without paying at Level Two and Level Three facilities.
The services are available at SHA-contracted facilities carrying the green label. These include Level Two, Level Three and selected Level Four facilities.
Patients can receive outpatient consultations, diagnosis and treatment for common illnesses, basic laboratory tests and essential medicines at the facilities. Where a patient requires more specialised attention, the facility can also refer them to a higher-level hospital.
SHA has at the same time been seeking to make contributions easier for Kenyans who may not manage to pay the required amount at once.
Through the "Lipa SHA Pole Pole" programme, members can make their contributions in smaller instalments. More than 600,000 people are currently active payers under the initiative.
The authority's total registration stands at 32 million Kenyans, including principal members and their dependants, according to Mwangangi.
The Council of Governors' state of devolution report, however, gives a slightly different figure, placing registered Kenyans at 32.2 million.
The report says the number has risen from 18 million, meaning more than 12 million additional people have been registered within one year.
The difference between the SHA figure and the Council of Governors' figure is attributed to the fact that the numbers were taken at different times.
The authority is also looking at ways of increasing contributions from the informal sector.
Workers in the formal sector contribute about Sh8 billion every month, while collections from the informal sector range between Sh500 million and Sh700 million.
SHA is applying proxy means testing to determine the monthly amount that should be paid by Kenyans in the informal sector.
It is also testing an agency system where agents would sell health insurance and earn commissions, in a model similar to the one used by private insurance companies.
Despite the increase in collections, SHA still has a large number of claims going through checks.
The authority has Sh29 billion in claims under manual review from county governments, private healthcare facilities and faith-based facilities.
The claims have been described as aged claims rather than recent submissions.
County government healthcare providers, as a group, are owed Sh4 billion by SHA.
Mwangangi said the authority normally settles claims within 90 days and described its record of paying providers as among the fairest in Kenya's insurance industry, including when compared with private medical insurers.
She said SHA has rejected Sh17 billion in claims, while another Sh13 billion has been sent back to providers because of missing documents.
Healthcare providers given returned claims have 14 days to correct the information and submit them again.
"When you hear a provider says SHA owes them, we normally look at the rejects and the returns and what has been paid," 'she said.
Separate figures from the Council of Governors show that referral hospitals have also recorded higher collections through Facility Improvement Financing (FIF).
Council of Governors chairperson Ahmed Abdullahi said FIF Act collections increased from Sh16.9 billion to Sh24.01 billion.
The new amount was above the annual target set for the financing system, giving referral hospitals more funds from the collections.
The figures come as the government continues to expand the new health financing system, with SHA reporting increased registration, higher collections and growing use of services by Kenyans.
The authority has also continued to direct funds towards healthcare providers while checking claims submitted by facilities.
"Taken together, the numbers point to a health financing system gaining both scale and momentum: more Kenyans covered, more money moving through the system, and referral hospitals collecting above what they were expected to" Mwangangi said.