President Ruto’s ambitious Social Health Authority (SHA) faces increasing challenges as patients increasingly seek larger hospitals, highlighting significant weaknesses in Kenya’s primary healthcare system and jeopardizing the sustainability of the new health financing model.
Although SHA is legally mandated and integral to Kenya’s Universal Health Coverage agenda, recent analyses reveal substantial operational deficiencies that hinder its effectiveness at the community level.
At the heart of this crisis lies a faltering Primary Health Care (PHC) system that many Kenyans no longer trust to adequately address their medical needs.
A recent evaluation by the Institute of Economic Affairs (IEA), conducted from November 2025 to January 2026, scrutinized SHA’s three funding pillars: the Primary Health Care Fund, the Social Health Insurance Fund (SHIF), and the Emergency, Chronic, and Critical Illness Fund (ECCIF). This review focused on financing, resource pooling, strategic purchasing, and administration.
John Mutua, IEA Programmes Coordinator, highlighted that the system struggles because patients bypass lower-level facilities, opting instead for Level Four and Five hospitals.
“Many individuals overlook the Primary Healthcare Fund and direct patients to higher-level hospitals due to a lack of specialists, which undermines SHA,” he stated on Tuesday, February 10, 2026.
Under the SHA framework, primary healthcare facilities are intended to serve as the initial point of contact, managing routine cases and referring more complex ones up the healthcare hierarchy.
However, in numerous regions, these facilities remain understaffed, inadequately equipped, and incapable of providing specialized services.
“For SHA to succeed, primary healthcare must function effectively. These gaps stem not from policy intentions but from execution,” Mutua emphasized, noting that the persistent bypassing of PHC facilities critically impacts the performance of the health financing system.
As a result, higher-level hospitals face congestion, extended waiting periods, and increased operational burdens.
This situation not only escalates costs but also undermines the referral-based structure that SHA relies on to manage expenditures and enhance efficiency.
The assessment also uncovered significant funding deficits across all three SHA funds, with compliance rates languishing at a mere 18 percent, thereby constraining the available resource pool.
Concerns regarding fairness and long-term fiscal sustainability have arisen due to weaknesses in the means-testing tool that determines individual contributions.
“Government reports indicate that SHA is functioning, but the public perceives otherwise. We encounter operational capability gaps within the system,” Mutua pointed out.
In addition to challenges in patient flow, SHA contends with a growing crisis in claims processing and reimbursement.
Health facilities have reported delays in payments, disrupting service delivery and daily operations.
“A crisis in claims processing and reimbursements is hindering facility operations and healthcare services,” Mutua remarked.
Financial pressures have compelled faith-based health providers to intervene. Leaders and administrators of mission hospitals are now urging SHA to promptly settle over Ksh10 billion in outstanding bills owed to these facilities.
They caution that without immediate resolution, some hospitals may reduce services or refuse patients, further burdening the public healthcare system.
Despite significant investments in digital systems and technologies, the assessment identified ongoing operational and capacity challenges. Suboptimal internet connectivity, shortages of medical specialists, and inadequate infrastructure continue to obstruct effective service delivery, particularly in rural areas.
Governance risks and equity concerns have also surfaced. Although SHA has achieved notable milestones, including the digital registration of over 29 million Kenyans, the rapid pace of implementation has surpassed the system’s readiness.
Kenya’s transition to SHA represents one of the most critical health reforms in recent years, designed to replace the National Health Insurance Fund with a more inclusive and transparent framework capable of delivering Universal Health Coverage.
However, as public discourse intensifies, this reform now stands at a pivotal moment. Experts caution that without urgent investments in primary healthcare, enhanced compliance, and expedited reimbursement processes, the promise of affordable healthcare for all may drift further out of reach.
For millions of Kenyans in search of dependable medical care, the success of SHA may ultimately hinge on the ability of the nearest clinic to provide timely assistance when it matters most.
