The success of the Social Health Authority (SHA) should be measured by whether Kenyans can receive treatment when they need it and not by the number of people registered, Nairobi Senator Edwin Sifuna has said, challenging President William Ruto's continued defence of the government's health insurance reforms.
Speaking during an interview on a local TV station on Tuesday, July 28, 2026, Sifuna said discussions with health facilities showed the new system was still facing major challenges despite government claims that it had improved healthcare financing and access.
"It is a difficult conversation in healthcare. We have had conversations with facilities. Our county hospitals are owed a lot of money," Sifuna said.
The senator said the government appeared to be using registration figures as the main measure of success instead of focusing on whether patients were receiving healthcare services.
"When you speak to the President, you get the sense that for him, the success of SHA is how many people have registered, and we are telling him this is not a national registration bureau," he said.
"We have a registration bureau. We have a register of persons. The success of our healthcare scheme cannot be how many people have registered. It should be how many people are actually accessing service."
SHA replaced the National Health Insurance Fund (NHIF) under the government's Universal Health Coverage reforms. The programme was introduced to widen access to affordable healthcare while reducing the amount patients pay from their own pockets.
Sifuna said one of the key promises behind the reforms was to end the need for Kenyans to organise public fundraising drives, commonly known as harambees, to settle hospital bills, but argued that many families were still relying on them.
"The promise of universal healthcare was that the spectre of harambees to be able to clear hospital bills would be a thing of the past. Do we still have harambees for those things? Yes, we do," he said.
He also questioned whether the higher contributions required under SHA were producing better healthcare for those who needed it most.
"The argument was that those of us who are in a position to give more should give more, so that those who don’t have are able to also access coverage," Sifuna said.
Using his own contributions as an example, the senator said he now pays more than Sh32,000 every month compared to less than Sh1,000 under NHIF.
"But still, you can see the complaints," he added.
Sifuna further pointed to reports that some hospitals had raised concerns over deductions made from SHA reimbursements.
"There was a recent story that hospitals discovered that there is a 2 per cent that is charged on their remittances, and nobody knows what that 2 per cent is for or where the money goes," Sifuna said.
"These are some of the issues so that we should be able to look each other in the eye and say there’s a problem here."
His remarks come just days after President William Ruto strongly defended SHA and dismissed calls to restore NHIF, saying the new health insurance system had delivered better results than its predecessor.
Speaking at State House, Nairobi, on Saturday, the President said returning to NHIF would reverse the gains already made under the reforms.
"Those asking us to return to NHIF are threatening the health of our people," Ruto said.
"If they want to know whether SHA is working, they should ask the Community Health Promoters."
According to the President, SHA is releasing an average of Sh12 billion every month to hospitals, compared with Sh5.6 billion under NHIF, which he said covered three months.
Ruto said the government had released Sh170 billion to health facilities over the past 18 months, including Sh32 billion to hospitals in Nairobi County.
He added that hospitals would receive another Sh12 billion for services provided this month and said medical equipment worth Sh10 billion had already been procured and installed through the reforms.
The President also announced that all 107,000 Community Health Promoters (CHPs) would receive medical insurance, with the national government contributing Sh390 million and county governments expected to match the amount.
Ruto said Community Health Promoters remain at the centre of the reforms and will continue registering households under SHA, educating families about available health services, making referrals and promoting preventive healthcare.
“Community Health Promoters are the first point of contact between Kenyans and their health system. Before patients reach a dispensary, health centre or hospital, they first meet you in their homes,” he said.
“You are not simply supporting healthcare reform. You are leading it from the frontlines.”