Health insurance coverage is still uneven across Kenya’s counties due to persistent income disparities, informality in employment and gaps in awareness, even as the country transitions to the new Social Health Authority (SHA) framework.
- •Data from the Gross County Product report show that counties with higher incomes and stronger formal sector employment record significantly higher health insurance uptake, while rural and arid regions continue to lag.
- •Urban counties such as Nairobi, Kiambu and Mombasa post the highest proportions of insured adults, driven by salaried employment and employer-linked contributions.
- •In contrast, counties in northern and parts of eastern Kenya, including Wajir, Mandera and Turkana, record some of the lowest coverage rates, mirroring high poverty levels and heavy reliance on informal livelihoods.
In these areas, out-of-pocket spending remains the dominant mode of healthcare financing, exposing households to financial shocks during illness.
The report underscores a strong correlation between income, financial inclusion and insurance uptake. Counties with higher participation in micro, small and medium enterprises (MSMEs) and better access to credit also tend to show stronger insurance penetration.
These disparities form the backdrop to Kenya’s recent overhaul of its public health insurance system. In late 2024, the government replaced the National Health Insurance Fund (NHIF) with the Social Health Authority (SHA), expanding coverage beyond formal workers and anchoring contributions on ability to pay rather than employment status.
Policymakers argue that SHA offers a more equitable foundation for universal health coverage. By linking contributions to income and integrating county-level data, the new system is expected to improve targeting, reduce catastrophic health spending and ease pressure on household finances.
