Differences between SHA and NHIF

Kenya’s shift from the National Hospital Insurance Fund (NHIF) to the Social Health Authority (SHA) marks one of the biggest healthcare reforms in the country’s history.

The transition replaces a decades-old system with a more expansive, structured, and mandatory model aimed at achieving universal health coverage. But what exactly has changed?

Contribution model: From fixed rates to income-based

One of the most significant differences lies in how contributions are calculated.

Under NHIF, members paid a fixed monthly amount ranging from KSh 150 to KSh 1,700, depending on salary bands. Contributions were capped, meaning high-income earners never paid beyond KSh 1,700.

SHA introduces a 2.75% deduction on gross income, with no upper limit. This means higher earners contribute more, while the minimum monthly contribution drops to about KSh 300—lower than NHIF’s KSh 500 for informal workers.

The new model is designed to create a more equitable system where contributions are aligned with income levels.

Access to care: Broader and more inclusive

NHIF required members to be fully paid up to access treatment, locking out many Kenyans who fell behind on contributions.

SHA changes this approach significantly:

• Primary healthcare and emergency services are accessible to all registered Kenyans, regardless of payment status
• Introduces a referral system, requiring patients to start at designated primary healthcare facilities before moving to higher-level hospitals
• Replaces physical cards with National ID and biometric verification

This shift aims to make healthcare more accessible, especially at the basic level.

Fund structure: One fund vs three-tier system

NHIF operated as a single pool of funds, which often struggled to meet diverse healthcare needs.

SHA introduces a three-tier system:

1. Primary Healthcare Fund – Covers basic and preventive care for all
2. Social Health Insurance Fund (SHIF) – Handles inpatient and outpatient services
3. Emergency, Chronic and Critical Illness Fund (ECCIF) – Covers high-cost treatments like cancer and dialysis

This structure ensures that different healthcare needs are funded separately, reducing strain on a single pool.

Scope of coverage: Expanded benefits

SHA significantly broadens what is covered compared to NHIF.

New or expanded benefits include:

• Preventive screenings for diseases like cancer and diabetes
• Chronic illness management with dedicated funding
• Palliative care services
• Assistive devices for persons with disabilities

Under NHIF, many of these services were either limited or subject to strict annual caps that patients could quickly exhaust.

Chronic illness support: A major shift

One of NHIF’s biggest challenges was handling long-term illnesses, where patients often exceeded their annual limits.

SHA addresses this through the Emergency, Chronic and Critical Illness Fund, which provides more sustainable financing for ongoing treatments such as dialysis and cancer care.

Key differences at a glance

What it means for Kenyans

The shift to SHA represents a move toward a more inclusive and sustainable healthcare system.

While some Kenyans—especially higher earners—may pay more under the new model, the government argues that the expanded coverage, guaranteed primary care, and improved funding for chronic illnesses will lead to better health outcomes nationwide.