Kenya’s health financing system is under growing pressure following new data on contributions and payouts under the Social Health Authority (SHA).
The 2026 Economic Survey from the Kenya National Bureau of Statistics (KNBS) reveals a widening gap between contributions collected and claims paid out in the financial year 2024/25.
The gap now raises concerns over the sustainability of the contributory health model.
Rising SHA Claims Outpace Contributions
The financial performance of the SHA-administered funds shows significant strain, particularly in the contributory Social Health Insurance Fund (SHIF).
During the 2024/25 period, SHIF collected a total of Ksh 57.7 billion in premiums from members across the formal and informal sectors, based on a 2.75% levy on gross income.
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However, total claims and benefit payments amounted to Ksh 91.5 billion, including Ksh 33.4 billion in claims liabilities.
This resulted in a payout ratio of 158.6%; the value paid exceeded the contributions collected in the same financial year.
Stable Performance in Exchequer-Funded Schemes
While the contributory fund recorded a deficit position, the exchequer-funded components of SHA remained relatively stable.
The Primary Health Care Fund (PHCF) received a total of Ksh 10.2 billion and disbursed Ksh 9.78 billion, resulting in a 95.5% payout ratio.
Emergency, Chronic, and Critical Illness Fund (ECCIF) received Ksh 1.3 billion and recorded a 95.2% payout ratio.
Rapid Growth in Membership Under New Health System
According to the KNBS report, the Social Health Authority, which transitioned from the National Health Insurance Fund (NHIF) in 2024, recorded 21.0 million registered members in the 2024/25 financial year.
“The Social Health Authority (SHA), which transitioned from National Health Insurance Fund (NHIF) in 2024, had about 21.0 million registered members in 2024/25,” read the report.
The gender distribution of registered members shows a slight female majority, with 51.7% female members compared to 47.3 percent male members.
However, data also indicate gaps in registration details. About 212,776 members did not specify their sex, and 4.4 million did not specify their county of residence.
The geographic distribution of members shows strong concentration in urban and high-population counties.
Nairobi City leads with 1.64 million members, followed by Kiambu with 832,307, Nakuru with 730,260, Mombasa with 704,375, and Kakamega with 700,043.
| Rank | County | Registered Members |
|---|---|---|
| 1 | Nairobi City | 1,635,778 |
| 2 | Kiambu | 832,307 |
| 3 | Nakuru | 730,260 |
| 4 | Mombasa | 704,375 |
| 5 | Kakamega | 700,043 |
| 6 | Bungoma | 574,181 |
| 7 | Kisumu | 545,448 |
| 8 | Machakos | 509,601 |
| 9 | Homa Bay | 487,475 |
| 10 | Bomet | 463,946 |
Counties classified as Arid and Semi-Arid Lands (ASALs) recorded a low uptake. Isiolo recorded 46,968, Lamu 66,457, Tana River 68,643, Samburu 69,027, and Marsabit 90,765.
| Rank | County | Registered Members |
|---|---|---|
| 1 | Isiolo | 46,968 |
| 2 | Lamu | 66,457 |
| 3 | Tana River | 68,643 |
| 4 | Samburu | 69,027 |
| 5 | Marsabit | 90,765 |
| 6 | West Pokot | 112,729 |
| 7 | Taita/Taveta | 151,901 |
| 8 | Garissa | 159,092 |
| 9 | Turkana | 166,997 |
| 10 | Tharaka-Nithi | 177,980 |
Health Spending Surges as Kenya Expands Facilities and Workforce in 2025
According to the KNBS Economic Survey 2026, Kenya’s health sector recorded significant growth in spending, infrastructure, and workforce in 2025, even as emerging trends in maternal health and disease patterns raise new concerns.
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Both national and county governments increased health expenditure, alongside expansion in facilities and medical personnel.
Health Spending and Infrastructure Expansion
Government spending on health services rose sharply during the period under review.
National Government expenditure increased by 22.8% to Ksh 150.9 billion in the 2025/26 financial year, while county governments’ spending grew by 23.3% to Ksh 133.4 billion.
The total number of operational health facilities rose by 4.6 % to 16,700 in 2025, largely driven by growth in Level 3 facilities, which provide primary healthcare services. Capacity improvements were also recorded, with hospital beds increasing by 5.0 per cent to 106,300, while the number of cots rose by 8.3 per % to 12,200.
At the national level, recurrent expenditure accounted for the largest share of spending, rising to Ksh 111.0 billion, equivalent to 73.5% of total health expenditure.
Total government expenditure on health is projected to increase from 3.0% in 2024/25 to 3.5% in 2025/26.
