By Samwel Doe Ouma

Health CS Aden Duale

Kenya is undertaking what Ministry of Health officials describe as the most ambitious overhaul of its health system in decades, aiming to replace the National Hospital Insurance Fund (NHIF), which they say was a fragile and opaque model, with the Social Health Authority (SHA), which they describe as a more digitally driven, financially sustainable and universally accessible system.

Speaking at the 53rd Annual Scientific Conference of the Kenya Medical Association in Naivasha, Health Cabinet Secretary Aden Duale said the reforms are intended to move the country “beyond resilience” toward a smarter, more inclusive health system.

The changes are anchored in the government’s Bottom-Up Economic Transformation Agenda and include a shift from NHIF to the Social Health Authority, which is expected to expand access to care while shielding households from catastrophic medical costs.

“We could no longer rely on resilience to mask structural inefficiencies,” Duale said. “The system was fundamentally broken.”

Expansion under SHA

Government data presented at the conference show rapid expansion under the new model. More than 30 million Kenyans have registered with SHA, with billions of shillings collected and disbursed across primary and specialized care.

Officials say more than 10,000 health facilities are now transacting under the system, enabling millions of Kenyans to access free primary healthcare and subsidized specialized services.

Doctors raise concerns

Doctors, through the Kenya Medical Association, have raised concerns over delayed reimbursements, claims processing challenges and operational uncertainty—issues the government acknowledged during the meeting.

Duale said the government is working to clear inherited debts from NHIF and streamline payment systems to restore trust among healthcare providers.

Digital push and fraud controls

At the center of the reforms is an aggressive digitalization strategy led by the Digital Health Agency.

Thousands of health facilities have been digitized and linked to a national health information exchange system, supported by widespread deployment of digital infrastructure across the country.

The government has also introduced an artificial intelligence-powered fraud detection system designed to flag anomalies such as duplicate claims, upcoding and fabricated records before payments are processed.

A key component of the rollout is the Practice 360 application, which allows clinicians to manage patient records and claims in real time. The system is geo-fenced to accredited health facilities to prevent fraudulent “ghost” admissions.

Pressure on health facilities

Despite these reforms, health workers continue to operate under strain.

Experts say delayed reimbursements and legacy debts from the former insurance system have strained hospital operations, with some providers warning of reduced service capacity.

The government maintains that SHA will improve payment timelines and strengthen verification systems, though concerns persist among providers navigating both financial uncertainty and new digital requirements.

Duale urged clinicians to remain engaged as the system stabilizes.

Supply chain and equipment reforms

The government also says it is addressing chronic shortages of medicines and equipment through reforms at the Kenya Medical Supplies Authority.

The agency is being restructured to improve transparency and ensure more reliable delivery of medical commodities.

Separately, a national equipment program is rolling out diagnostic tools such as CT scanners and digital X-ray machines across county hospitals under a pay-per-use model designed to avoid past inefficiencies.

Workforce and regulatory reforms

Officials say the success of the reforms depends heavily on healthcare workers.

The government is developing a national policy to define working conditions, protections and career structures for medical professionals, including frameworks for medical interns.

A multi-sector technical working group has also been established to harmonize training standards and align medical education with evolving healthcare demands.

Regulatory reforms are also underway to reduce overlapping licensing requirements imposed by national and county governments.

Legislative agenda

To entrench the reforms, the government is advancing several bills in Parliament, including proposed legislation on patient safety and quality of care, alongside amendments to existing health laws.

Duale called on medical professionals to actively participate in shaping the reforms, describing the process as a shared national undertaking.

“This transition is historic,” he said. “It requires collaboration, trust and shared responsibility.”

A system in transition

While the reforms signal a major shift toward universal health coverage, their success will depend on how quickly operational challenges are resolved and whether trust can be rebuilt between the government and frontline providers.

For now, Kenya’s health sector remains at a critical crossroads balancing ambitious reform with the practical realities of implementation.