By Dr. Ngatia Gikere
Kenya is undergoing a quiet but profound transformation in how it finances healthcare.
The country’s new Social Health Insurance Fund (SHIF), launched in late 2023, replaced the long-standing National Hospital Insurance Fund (NHIF) last October, signalling an ambitious turn toward universal health coverage. In its first year, SHIF has already encountered the growing pains that often accompany sweeping policy reforms, including gaps in public understanding, questions around infrastructure, and the inevitable lag between policy and practice.
Yet for all its complications, SHIF represents an opportunity to rethink how health benefits are structured, delivered, and aligned with a broader vision of equity and universal health coverage.
At the heart of SHIF is a radical shift in principle. Health insurance, long tethered to formal employment and often out of reach for informal workers, is now being reframed as a public good. For the first time, salaried and non-salaried Kenyans contribute at a flat rate of 2.75 per cent of income, with state guarantees for those unable to pay. This extends the safety net beyond traditional boundaries.
However, that vision is encountering early turbulence. Projections that SHIF would raise KSh157 billion in its first year have since been revised downward to KSh67 billion, falling short even of NHIF’s final collections. The numbers reflect a more profound unease with confusion over how the fund integrates with existing employer schemes, uncertainty over the services it guarantees, and limited communication on what compliance looks like.
This is where employers come in.
Corporate Kenya holds the potential to catalyze public understanding and uptake of the SHIF model and insurance as a whole. As of 2023, health insurance penetration in Kenya remained dismally low at 2.3 percent of gross domestic product, far below the global average. For most Kenyans, coverage is either unaffordable or seen as a regulatory box to check. Companies, especially large employers, have the influence and resources to change that narrative both for their employees and for the health system as a whole.
But doing so requires a keen strategy and not just good intentions.
Employers must now ask tough questions: Does SHIF duplicate, supplement or complement [DG1] our existing medical schemes? Should we retain top-up plans, or redesign them altogether? What does compliance mean in real terms? And, How do we prepare for health outcome and quality audits or employee concerns down the line?
Such are the questions that advisory firms like Minet can help answer. With regulatory frameworks still evolving, focused support will help employers navigate the grey zones, through policy audits, risk modelling, and hybrid insurance models that pair SHIF’s base coverage with specialized employer-sponsored benefits. The aim is to adapt to the new system and shape it.
Because beyond cost considerations, SHIF sits at the intersection of business strategy and social responsibility, presenting an opportunity for corporate leaders to align employee health with environmental, social and governance (ESG) goals. Done right, this could allow businesses to redirect spending from curative services toward preventive care, mental health, and workplace wellness. These areas are historically underfunded, yet critical to long-term productivity.
It’s also a matter of competitiveness. In a tight labour market, quality health coverage remains one of the most attractive non-cash benefits an employer can offer. Companies that move early to integrate SHIF into coherent, compliant, and comprehensive health plans will likely stand out in terms of employee retention, reputation, and readiness.
There is still work to do. Much depends on the government’s ability to build public trust, improve benefit packages, and deliver timely and efficient services. However, much also depends on the private sector’s willingness to engage, influence, and lead.
The question is whether or not they will do it.
The writer is the Health Risk Advisor at Minet Kenya
