Kenya’s pursuit of universal health coverage has evolved over three decades through incremental reforms. But by far the boldest step taken so far was in 2022 when the government embarked on an overhaul of the healthcare system under President William Ruto’s economic transformation agenda.
Kenyan doctors demonstrate outside the health ministry to demand better conditions in April 202
The new Social Health Insurance Fund – implemented across the country from October 2024 – replaces the 58-year-old National Health Insurance Fund and aims to provide all Kenyans with quality healthcare. Under the Social Health Insurance Act, passed in 2023, the new scheme mandates health coverage for all. It is backed up with regulations requiring the mandatory registration of all residents of Kenya.
The new healthcare system introduces the Primary Health Fund for basic care at local clinics, the Social Health Insurance Fund for advanced services at larger hospitals, and the Emergency, Chronic and Critical Illness Fund to cover emergency and long-term treatments.
The transition from the old system to the new marks a significant milestone in Kenya’s efforts towards universal health coverage. It’s the first time the government is fully overhauling the country’s health insurance system and addressing its perennial issues of inefficiency, corruption and service delivery head on. Previous efforts have opted for piecemeal reforms.
But the transition from the National Health Insurance Fund is facing serious challenges. These include financing gaps, reimbursement delays and infrastructure constraints that affect service delivery. In addition, the changes are being met with public resistance, low registration rates and concerns about the new member contribution model.
