The National Assembly’s Departmental Committee on Health has raised alarm over funding shortfalls and premium contributions in the Social Health Authority (SHA).
Speaking on Thursday, March 19, in Mombasa County, Seme Member of Parliament James Nyikal, who chairs the committee, said the funding shortfall threatens the sustainability of the medical scheme.
Nyikal noted that the revenue collected by the authority is not enough to meet its expenses.
According to the MP, SHA collects about Ksh7.4 billion monthly but spends Ksh7.2 billion on its expenses.
“The revenue that the Social Health Authority collects for the three funds is really not enough to meet its expenses. As things stand now, they are barely getting what they need to run. We are likely to face an issue of sustainability,” the Seme lawmaker stated.
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Nyikal linked the imbalance between revenue and expenditure in SHA to low participation from the informal sector, which is expected to contribute the bulk of funding under the Social Health Insurance Fund (SHIF).
“Those in formal employment remit their contributions directly through employers, and that has remained the main source of income.
“But we expect a larger portion to come from the informal sector, and this is where the challenge lies,” Nyikal said.
The Seme MP disclosed that about 29 million Kenyans have registered under the medical scheme, but only five million of them are actively paying premiums.
However, Nyikal defended the SHA model but pointed out gaps in the implementation of its medical scheme.
“My view about the whole thing, the design and the concept, is good. The problem we are going through is a problem of implementation,” Nyikal said.
Besides the funding concerns, the Health Committee flagged adverse selection, where individuals only enroll when sick as another major risk to the system.
The committee also pointed to weaknesses in the benefits package, saying it is not fully aligned with the cost of care or comprehensive enough to meet patient needs.
This comes a week after SHA announced the release of billions of shillings to healthcare providers across the country in settlement of approved medical claims.
SHA CEO Mercy Mwangangi, in a statement on Friday, March 13, said the authority had begun releasing the funds to settle verified claims submitted by healthcare facilities.
"In our continued commitment to supporting our healthcare infrastructure, we are pleased to announce the release of Ksh11.1 billion towards the settlement of approved claims under the Social Health Insurance Fund (SHIF).
“The disbursement of these funds has officially commenced today, Friday, 13th March 2026," she said.
Mwangangi clarified that the payments would not be released all at once but would instead follow a structured schedule.
She further reassured healthcare facilities that all approved claims under SHIF would be paid within the stated timeline.
"We wish to reassure all facilities that every successfully processed and approved SHIF claim will be settled within this period," she continued.
