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Kenya’s transition to the Social Health Insurance Fund (SHIF) was designed to bring equity, affordability, and inclusivity to healthcare. But for the country’s largest demographic, its youth, the promise of accessible, reliable healthcare remains elusive. With over 75 percent of the population under 35, a youth-centered approach to SHIF is not just desirable; it is essential for the system’s long-term sustainability and credibility. But several months into its implementation, major gaps in clarity, equity, and sustainability are emerging posing serious questions about whether the system can truly deliver universal health coverage.

Affordability and Payment Flexibility Still in Question

One of the most contentious aspects of SHIF is its contribution model. Initially set at 2.75% of household income, many in the informal sector found the rate too high and confusing. The government later introduced a minimum monthly payment, which climbed from an expected Sh300 to Sh600 or more a change that left many potential contributors discouraged or unable to enroll.

In response, the government recently launched Lipa SHA pole pole, a more flexible payment method that allows daily, weekly, or monthly contributions starting from as little as Sh20 a day. The new model, announced by President William Ruto during Madaraka Day celebrations, aims to accommodate low-income earners and boost participation among informal workers.

While this initiative is a step toward inclusivity, questions remain about whether payment flexibility alone is enough to ensure wide uptake, especially when contributors still struggle with other systemic issues.

Confusion Over Dependent Coverage

A major concern undermining public trust in SHIF is the process for registering dependents. Under the Social Health Authority (SHA), only spouses, children under 21, and certain categories of dependents such as students aged 21 to 25 or disabled family members are eligible for coverage. However, the process for verifying eligibility, especially for adult dependents in education, is unclear and bureaucratic.

This has led to frustration among many Kenyans who support older children or disabled relatives but are unable to register them without complex documentation or additional payments. Without a streamlined, transparent process, the system risks excluding the very people it aims to protect.

Limited Coverage Weakens Impact

Even for those who manage to register and contribute, SHIF has been criticized for offering limited coverage. Many beneficiaries have found that critical services including chronic illness treatment, outpatient care, and specialist services are either not covered or require out-of-pocket payments.

This undermines the core principle of health insurance: financial protection against the high costs of medical care. Without expanded and reliable benefits, SHIF risks becoming a nominal safety net with limited real-world impact.

Low Contribution Rates Raise Viability Concerns

As of early 2025, over 20 million people had registered for SHIF; but only 3.9 million were actively contributing. This imbalance raises serious concerns about the long-term sustainability of the fund. With such a low proportion of contributors, the scheme may struggle to generate enough resources to provide meaningful healthcare services to the population.

Uncertainty around contribution requirements, especially among informal sector workers, has also contributed to the slow uptake. Many are unsure who qualifies as indigent and who must pay the minimum Sh300 monthly fee, leading to hesitation and inconsistent engagement.

Ongoing Reforms Underway

To address these systemic shortcomings, the Ministry of Health has launched a Health Benefit Package Tariffs Review Committee. This team is tasked with harmonizing benefit structures, simulating provider payment models, and developing data-driven strategies to integrate donor-supported programs into the SHIF framework.

Health Cabinet Secretary Aden Duale has emphasized the need for affordable and evidence-based coverage that reflects Kenya’s healthcare realities. The committee is expected to propose new tariffs, enhance policy direction, and improve coordination with counties to expand access and infrastructure.

Conclusion: Progress with Persistent Challenges

While SHIF has made strides in modernizing Kenya’s healthcare financing, its success hinges on resolving key issues: affordability, coverage clarity, and ease of enrollment , especially for dependents. Flexible payment options like Lipa SHA pole pole may widen the door, but meaningful progress will depend on how accessible, transparent, and comprehensive the system becomes. To build a truly inclusive health system, Kenya must also meet its young people where they are financially, socially, and technologically. SHIF must be tailored to the needs and realities of a generation that represents not only the majority, but also the future of the country.

If these gaps remain unaddressed, SHIF risks repeating the inefficiencies of the NHIF it replaced. True universal health coverage must be more than a promise;it must be a system that works for everyone, especially the most vulnerable.

By Caroline Kamau, Blessed Citron 

Photo Credits: tv47 digital