Scaling Health System Reform through Universal Health Insurance in Kenya
Download the Full PaperExemplar Overview
This exemplar reviews Kenya's 2023 healthcare legislative overhaul, which replaced the 50-year-old NHIF with the Social Health Authority (SHA) and established three specialized funds to manage mandatory health insurance.
In October 2023, Kenya enacted four healthcare acts: the Social Health Insurance Act (establishing the Social Health Authority to replace the NHIF), the Primary Health Care Act, the Digital Health Act, and the Facility Improvement Financing Act. Premium contributions for salaried workers are set at 2.75% of gross income. For self-employed and informal workers, contributions are determined through an AI-enabled means test with a monthly floor of KES 300. In December 2025, Kenya signed a National Health Compact committing to double public health spending over five years to reach 5% of GDP and expand insurance coverage from 26% to 85%.
Policy Recommendations
Passing a package of linked laws simultaneously ensures that financing, service delivery, digital health, and facility autonomy remain aligned.
Rapid enrollment can outpace administrative systems; means-testing and provider reimbursement processes must be fully functional to preserve trust.
Enabling public facilities to retain and reinvest their revenues locally preserves operational autonomy and improves frontline service quality.
A unified purchaser model (SHA) reduces pooling fragmentation compared to a system with multiple competing public and private funds.
Key Numbers
Registered members in the Social Health Authority
Premium contribution rate of gross income for salaried workers
Health facilities enrolled in the SHA system
Target share of GDP for public health spending by 2030
Key Findings
Kenya restructured its health system by passing four interconnected laws covering insurance, primary care, digital health, and facility financing.
SHA registration reached 27 million people by October 2025, up from zero at launch in October 2024.
Over 8,813 health facilities were accredited and enrolled in the Social Health Authority system within the first five months.
The government signed a National Health Compact committing to double health spending to 5% of GDP and expand insurance to 85% by 2030.