As Kenya rolls out Universal Health Coverage, many citizens keep hearing two terms that sound almost the same — SHA and SHIF. This has led to widespread confusion, especially in hospitals, where patients are often told: “SHA only covers inpatient services. Outpatient is not covered.” This statement is misleading.

To understand the truth, we must clearly separate who manages the system from who pays for which services.

What Is SHA (Social Health Authority)?

The Social Health Authority (SHA) is a public institution created by the Social Health Insurance Act, 2023. It replaced the former National Hospital Insurance Fund (NHIF).

SHA is not a hospital and does not provide treatment. Instead, it is the body responsible for running and supervising Kenya’s social health insurance system.

In simple terms, SHA is the manager of the health insurance system.

Its responsibilities include:

• Registering Kenyans into the health system
• Collecting contributions
• Managing health insurance funds
• Paying hospitals and health facilities
• Setting benefit packages
• Ensuring accountability and quality of care

What Is SHIF (Social Health Insurance Fund)?

The Social Health Insurance Fund (SHIF) is not an institution. It is a fund — a pool of money — created under the same law and managed by SHA.

In simple terms, SHIF is the main wallet used to pay for health services.

SHIF mainly pays for:
• Inpatient services
• Surgery
• Specialist care
• Referrals
• Advanced diagnostics

This is why many hospitals associate SHIF — and wrongly, SHA — with admission and inpatient care.

Why People Think SHA Only Covers Inpatient Care

This misunderstanding comes from how the new UHC system was designed.
Under the current framework, outpatient services were intentionally separated from SHIF and placed under a different funding stream known as the Primary Healthcare Fund.

What does this means?Outpatient and preventive care are mainly funded through public financing at primary health facilities. Inpatient and specialised care are mainly funded through SHIF

Because hospitals deal more directly with SHIF claims, patients are often told that “SHA is for inpatient”, even though SHA manages the entire system, not just one fund.

The Three Funds Managed by SHA

To fully understand UHC, it is important to know that SHA manages three separate funds:
Primary Healthcare Fund (PHCF)
This fund covers:
• Outpatient care
• Preventive and promotive services
• Maternal and child health
• Community health services
• First contact with the health system

Social Health Insurance Fund (SHIF)
The fund covers:
• inpatient care
• Specialised and referral services
• Major procedures and surgery

Emergency, Chronic and Critical Illness Fund

This fund covers
• High-cost treatments
• Cancer care,
• Dialysis,
• ICU,
• Emergencies

All three funds work together under one system managed by SHA.

Why the Government Structured It This Way

This separation was done deliberately to:
• Bring basic health services closer to communities
• Reduce congestion in hospitals
• Ensure outpatient care is accessible even to the uninsured
• Protect insurance funds from overuse and fraud
• Reserve SHIF for serious and costly medical conditions

Under the old NHIF system, small outpatient claims consumed a large share of funds, leaving less money for serious illnesses. The new model aims to correct this imbalance.

It is important to note that:
✔ SHA does not exclude outpatient care
✔ Outpatient care still exists and is legally protected
✔ It is mainly funded through primary healthcare, not SHIF
✔ SHIF focuses on inpatient and specialised services
✔ All services fall under the broader Universal Health
Coverage system

Why we need to know This!
When people believe outpatient care is not covered:
• They delay seeking treatment
• Minor illnesses become serious
• Confidence in UHC declines

Clear understanding empowers citizens to:
• Seek care at the right level
• Demand services they are entitled to
• Hold government and facilities accountable

In Summary

SHA is the authority that manages Kenya’s social health insurance system, while SHIF is one of the funds — mainly paying for inpatient and specialised care — within that system. Outpatient services have not been removed; they are financed differently under primary healthcare.
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