• Author: Raymond
• Category: Medical Insurance in Kenya

How SHA Works in Kenya: Registration, Benefits & Access

Learn how SHA works in Kenya, including registration, contributions, dependants, healthcare funds, facility access, referrals and private medical cover.

How the Social Health Authority (SHA) Works in Kenya

Kenya’s Social Health Authority, commonly called SHA, manages the country’s public healthcare financing system. It was established under the Social Health Insurance Act, 2023 and took over the role previously performed by the National Health Insurance Fund (NHIF).

The short answer is that SHA registers households, collects or coordinates contributions, purchases healthcare services and pays contracted healthcare providers through three separate funds. Your access to a service depends on the relevant fund, the current benefits package, the facility’s participation, referral rules and any applicable authorisation requirements.

This guide explains how SHA works in practical terms for employees, self-employed people, families and employers in Kenya.

What is the difference between SHA and SHIF?

SHA and SHIF are not the same thing.

• SHA — Social Health Authority: The public body that administers Kenya’s social health insurance system.
• SHIF — Social Health Insurance Fund: One of the funds administered by SHA. It finances eligible healthcare services for registered members and their dependants, subject to the applicable rules and tariffs.

SHA also administers the Primary Healthcare Fund and the Emergency, Chronic and Critical Illness Fund. In simple terms, SHA is the administrator; SHIF is one part of the financing structure.

The three funds managed by SHA

1. Primary Healthcare Fund (PHCF)

The Primary Healthcare Fund finances eligible primary healthcare services at participating facilities. This is the first level of care for needs such as assessment, basic treatment, preventive services and other services included in the current primary-care benefits package.

Primary care is designed to be the normal entry point into the health system. When a patient needs more specialised treatment, the attending provider may issue a referral to a higher-level facility.

2. Social Health Insurance Fund (SHIF)

SHIF finances eligible healthcare services under the published benefits package and tariffs. Depending on the service and current rules, this may include outpatient, inpatient, maternity, diagnostic, surgical and specialist care.

Registration alone does not mean that every procedure, medicine or hospital bill will be paid in full. Limits, tariffs, clinical criteria, referrals, preauthorisation, provider contracts and exclusions can affect the amount payable.

3. Emergency, Chronic and Critical Illness Fund (ECCIF)

ECCIF supports eligible emergency treatment and specified chronic or critical-illness care under the law and applicable regulations. It is not an unlimited general medical account. Access and payment depend on the prescribed benefits, clinical requirements and approved facilities.

For a detailed explanation of the three funds, read Difference Between SHA, PHCF, ECCF and SHIF in Kenya.

Who should register for SHA in Kenya?

Kenyan residents are required to register with SHA under the applicable social health insurance framework. A household should provide accurate information about its principal member and eligible dependants.

Typical registration details may include:

• National ID, passport or another accepted identification document
• Mobile phone number
• Personal and household information
• Employment or income information
• Spouse and dependant details
• Supporting documents requested for dependants

Registration requirements and digital procedures can change. Use the official SHA or Afya Yangu channel and confirm that every eligible family member appears correctly before seeking treatment.

How to register for SHA

You can begin registration through the official digital channels, including the Afya Yangu portal or the SHA USSD service by dialling *147#. Assisted registration may also be available through authorised registration points.

The usual process is:

1. Enter and verify your identification and mobile number.
2. Complete your personal and household details.
3. Declare the requested employment or income information.
4. Add eligible dependants and provide the required supporting details.
5. Review the information carefully before submission.
6. Complete any identity or biometric verification required for access to care.

Do not use unofficial agents or share your PIN or one-time password with strangers. If your name, ID number, date of birth or dependant details are wrong, correct them through an official SHA support channel before you need treatment.

How SHA contributions work

Salaried households

For a person in salaried employment, the statutory contribution is generally calculated at 2.75% of gross salary or wages, subject to the minimum prescribed in the regulations. The employer deducts and remits the contribution within the required period.

For example, 2.75% of a gross monthly salary of KSh 50,000 is KSh 1,375. This illustration does not include any future regulatory changes, adjustments or individual circumstances.

Employees should check their payslips and SHA status. A deduction on a payslip does not, by itself, prove that the contribution has been successfully reflected in the member’s account.

Non-salaried households

For households without regular salaried income, the contribution is determined using the prescribed household-income assessment process. Payment frequency and the assessed amount should be confirmed on the official platform before payment.

Because contribution rules can be amended, do not rely on an old social-media post or an outdated article when budgeting. Check your current assessment and payment status directly through SHA.

Households needing financial assistance

The legal framework provides for government support for households identified as unable to pay, subject to assessment, eligibility and available public funding. A person should complete the official assessment process rather than assume that registration automatically qualifies the household for a subsidy.

How to add a spouse, child or other eligible dependant

Log in through the official member channel and confirm whether the dependant has been added and verified. You may be asked for identification, birth, marriage, guardianship or other evidence, depending on the relationship and the dependant’s age.

Before a planned hospital visit, confirm that:

• The dependant’s name and identification details are correct
• The relationship has been accepted
• The dependant is shown as eligible or active
• Any required contribution is reflected

Correcting a dependant record at the hospital can delay non-emergency care, so review the household profile in advance.

How to access healthcare using SHA

The practical patient journey normally follows these steps:

1. Confirm your status. Use the official SHA eligibility checker or member channel before a planned visit.
2. Choose a participating facility. Confirm that the facility is currently contracted or authorised for the service you need. Participation can differ by service, not just by hospital name.
3. Carry accepted identification. The facility may verify your identity and eligibility digitally or biometrically.
4. Start at the appropriate level of care. Non-emergency treatment may require you to begin at a primary-care facility.
5. Obtain a referral when required. Specialist or higher-level care may require a valid referral.
6. Allow the provider to request authorisation. Some admissions, tests, procedures or medicines may require approval before treatment.
7. Ask about uncovered costs. Before a non-emergency procedure, request an explanation of the approved tariff, any limit and any amount you may have to pay.

In a genuine emergency, seek immediate medical help. Administrative and payment questions can be addressed in accordance with the emergency-care rules once the patient is stabilised.

What healthcare services can SHA pay for?

The precise answer depends on the current benefits package and tariffs. Eligible services may include:

• Primary and preventive healthcare
• Outpatient consultations and treatment
• Inpatient admission
• Maternity and newborn care
• Laboratory tests and diagnostic imaging
• Prescribed surgical procedures
• Emergency services
• Renal care, oncology and other specified chronic or critical-illness services
• Rehabilitation or other services where included in the published package

Always verify the particular service, facility and approval requirements. A hospital being associated with SHA does not guarantee full payment for every treatment offered there.

Why might a SHA claim or hospital request be delayed?

Common reasons include:

• Inactive or unconfirmed eligibility
• Contributions not yet reflected
• Incorrect member or dependant information
• A facility not being contracted for the requested service
• Missing referral or preauthorisation
• A service falling outside the applicable package or tariff
• Exhaustion of a limit or failure to meet clinical criteria
• A system, identity-verification or provider-claim issue

If care is not authorised, ask the facility for the specific reason. Keep screenshots, payment confirmations, referral documents and any reference numbers. Escalate unresolved account issues through official SHA support channels.

Does SHA replace private medical insurance?

Not necessarily. SHA provides statutory public healthcare financing, while private medical insurance can offer different hospital networks, higher limits, broader benefits, international options or additional convenience, depending on the policy.

For many families and businesses, the practical strategy is to understand what SHA pays first and then use suitable private insurance for eligible gaps. Coordination varies between insurers and facilities, so never assume that two covers will automatically settle the same bill.

To compare private medical insurance options from multiple insurers, use the Imana Insurance quotation comparison landing page. For professional insurance guidance and company information, visit the Imana Insurance Agency authority website. You can also explore digital travel and insurance solutions through MyKava.

For a focused comparison, read Understanding SHIF vs Private Health Insurance in Kenya.

Frequently asked questions about SHA in Kenya

Is SHA the same as NHIF?

No. SHA is the authority established under the Social Health Insurance Act, 2023. It administers the new financing framework that replaced the former NHIF system.

Is SHA the same as SHIF?

No. SHA is the administering authority. SHIF is one of the three funds it manages.

How much does a salaried employee contribute to SHA?

The regulations generally prescribe 2.75% of gross salary or wages, subject to the statutory minimum and any later amendments. Confirm the current amount on your payslip and official SHA record.

Can I use SHA at any hospital in Kenya?

No. The facility must be appropriately licensed and participating for the relevant service. Confirm this before planned treatment.

Does SHA pay every hospital bill in full?

No. Payment is governed by the benefits package, tariffs, limits, referrals, authorisation rules and clinical criteria. A patient may still face costs that are outside the approved benefit.

Can I have SHA and private medical insurance together?

Yes. Private medical insurance may complement SHA, but the way benefits are coordinated depends on the insurer, policy and healthcare provider.

How can I check whether my SHA cover is active?

Use the official SHA eligibility checker or member portal. Check both the principal member and every dependant who may need treatment.

Final guidance

SHA works best when you complete four tasks before a medical need arises: register correctly, keep contributions current, verify all dependants and confirm the right participating facility for the required service.

SHA is an important foundation, but it should be part of a broader healthcare-financing plan. Review your family’s hospital preferences, medical needs and financial exposure, then compare suitable private medical insurance if you need additional protection.

Author

Raymond Momanyi
Founder & CEO, Imana Insurance Agency Kenya Ltd

Reviewed for publication: 11 September 2026. SHA benefits, tariffs, contribution procedures and provider participation may change. Readers should verify current details through official SHA channels before making healthcare or financial decisions.