The Social Health Authority (SHA) says Kenyans who cannot afford their annual health insurance contributions still have routes to treatment, with the government paying in full for households that have been verified as indigent.

Jacqueline Ngonyo, SHA's senior officer for registration and compliance, set out the options on Monday, 26 October 2026, amid continuing complaints that the cost of premiums under the Social Health Insurance Fund (SHIF) is locking some low-income families out of care.

Three groups in the informal sector

Ngonyo said households outside formal employment fall into three broad groups. Some can pay their full annual premium without difficulty. Others can manage only if payments are spread out, which is where the Lipa Pole Pole instalment plan comes in. A third group cannot pay even in instalments.

"Those in the informal sector, we have those who are able to comfortably afford their annual premiums and pay to SHA," Ngonyo said, adding that those at the bottom "have been clearly identified by the government as indigents."

For that last group, contributions are fully covered by the national government once a household's status has been confirmed through means testing. Ngonyo also appealed to Kenyans who are able to do so to sponsor vulnerable relatives and neighbours so that they can access services under the scheme.

How contributions are set

Salaried workers contribute 2.75 per cent of their gross pay, which employers deduct and remit monthly. For the self-employed and those in the informal sector, the amount is determined by means testing, which assesses a household's income and ability to pay. Older people, vulnerable children and poor households identified by the government fall under the indigent category.

Lipa Pole Pole conditions

To use the Lipa Pole Pole option, a member must register with SHA, complete means testing on the Afya Yangu portal, be registered with the Hustler Fund and have no outstanding defaults. Cover is activated after the member either pays the first four months upfront or clears existing arrears.

Members can check their financing limit by dialling *147# or *254#, choosing the option for Kenyan citizens, entering their national ID number and following the Make Payment, Pay for Self and Lipa Pole Pole prompts. Repayments can be made daily, weekly or monthly, and members can authorise an M-Pesa Ratiba standing order to automate them.

Guidance cited by Kenyans.co.ke indicates that the financing attracts interest and that missing a 30-day payment cycle can lead to cover being deactivated, so members are advised to keep up with instalments.

Care without contributions

Kenyans who cannot pay at all are not entirely shut out. Under the Primary Health Fund, basic services at Level 1, 2 and 3 public and mission facilities, including those delivered through Community Health Promoters, are available free of charge.

The Emergency, Chronic and Critical Illness Fund (ECCIF) separately covers emergency treatment and stabilisation as well as critical and chronic conditions such as cancer management and dialysis, without requiring a member to be up to date with contributions.

Pressure on the scheme

The clarification comes at a busy time for the authority. Over the weekend SHA announced it was resuming verification of old National Hospital Insurance Fund claims of Sh10 million and above owed to hospitals, part of a long-running dispute over pending bills inherited from the defunct fund.

Low compliance among informal-sector workers, who make up the bulk of Kenya's workforce, has long been flagged as a threat to the financial sustainability of SHA. The authority's message on Monday was aimed at both sides of that problem: encouraging those who can pay to do so in manageable instalments, while reassuring the poorest that the State will carry their premiums.

Photos: Kenyans.co.ke (SHA offices, Nairobi); Tech. Sgt. Daniel St. Pierre/US Air Force via Wikimedia Commons, public domain (patients at a Kenyan health facility)