The Slipshod State of SHA

SHA Online Platform

A few months ago, I wrote an article about my experience trying to use SHA, Kenya’s new health system. I went through the USSD, *147#, and the online portal, afyayangu.go.ke, expecting a straightforward process. Instead, I ran into basic problems. Unknown dependants appeared under my profile. I could not properly add my own ID. Most concerning, I could not even tell what I was supposed to pay as my monthly premium.

At the time, I assumed these were early-stage issues that would be fixed quickly. That is usually the expectation with a major national rollout. You expect some friction at the start, but you also expect rapid correction.

Recently, I tried accessing the system again, and incredibly, the experience had not meaningfully improved at all.

When a system of this scale is still struggling with basic functionality months after launch, it points to deeper problems in execution. These are not advanced features. They are the core building blocks of the system. If those are unstable, everything else rests on weak ground.

To understand the weight of this challenge, we have to look at what SHA replaced. The NHIF system had clear and widely documented failures. It mainly served formal sector workers and left a large portion of the population either uncovered or inconsistently enrolled. Benefits were limited and often focused on inpatient care.

Over time, NHIF also ran into financial and governance problems. Claims rose sharply and often consumed most of the contributions. Administrative costs were high and hospitals were paid late. In some cases, they began rejecting NHIF cards altogether. There were also repeated reports of fraud, ghost beneficiaries, and weak oversight. Public trust declined steadily.

The transition to SHA was meant to fix these issues. The new system promised universal coverage, income-based contributions, and a broader package of services including outpatient care and chronic illness support. On paper, it is a more complete and more equitable model.

But a better design on paper does not guarantee a working system in practice.

Several months into implementation, SHA is already showing worrying signs. Registration numbers are high, which is often presented as success. But registration is not the same as participation. Many people, especially in the informal sector, are not consistently contributing. At the same time, there are ongoing concerns about delayed payments to healthcare providers, which echoes the very problems NHIF struggled with.

Then there is the digital system itself. Costing billions and meant to simplify access and improve efficiency, the system is an utter failure and a harsh indictment on those in charge of its creation. If users cannot verify their information, update their details, or clearly understand what they owe, the system becomes impossible to engage with. This confusion causes disengagement, and this weakens the entire model.

It is often suggested that the main problem with SHA is lack of compliance by citizens. That people are not paying or not taking the system seriously. This explanation is too simple. Many Kenyans operate in the informal economy. Their incomes are unpredictable. Asking for consistent contributions based on unclear or sometimes inaccurate calculations is already a challenge. When the system itself is difficult to use, the burden shifts unfairly onto the user.

At this point, a more direct assessment is necessary. A reform of this scale should not still be struggling with basic user functions months after it has started. These are not rare or technical edge cases. They are everyday interactions that millions of people depend on.

Other countries show that success is possible, but it requires disciplined execution. Rwanda achieved high coverage through strong local implementation and targeted subsidies. Thailand built a stable system through consistent public funding and a focus on primary care. In both cases, the systems were made to work in practice, not just in policy documents.

SHA is proof that we are repeating familiar patterns in our governance. A strong idea is introduced, expectations raised, and then implementation falls short.

Universal healthcare is not optional. If the system meant to provide that is unreliable, people will lose confidence in it. SHA is not beyond repair though. The vision behind it is sound, but vision alone does not deliver results. Competence, transparency, and consistency must be part and parcel of any vision. Unfortunately, these seem to be utterly lacking in the MOH, and it is ordinary Kenyans who continue to bear the consequences.

Elijah is the Executive Director of Youth Advocacy Africa, a youth-serving NGO based in Kenya.