Four in ten Kenyans hold some form of health insurance, and the Social Health Authority (SHA) covers most of them.
The 2025/26 Kenya Mini Demographic and Health Survey, run by the Kenya National Bureau of Statistics (KNBS), puts coverage at 40% of the household population. The figure hides a gap of 53 percentage points between counties, from 67% in Nyeri to 14% in Tana River.
Where coverage is highest and lowest
Urban residents hold cover at a higher rate than rural residents, 44% against 38%. Income divides people more than location does. Among the richest fifth of households, 52% hold insurance. Among the poorest fifth, 24% do.
County results follow the same line. Nyeri leads, while Tana River records the lowest coverage. Isiolo, Garissa and Mandera also sit near the bottom.
| Group | Share with health insurance |
|---|---|
| Nyeri County | 67% |
| Richest fifth of households | 52% |
| Urban areas | 44% |
| Kenya overall | 40% |
| Rural areas | 38% |
| Poorest fifth of households | 24% |
| Mandera County | 24% |
| Garissa County | 23% |
| Isiolo County | 19% |
| Tana River County | 14% |
What SHA replaced
The Social Health Insurance Act, 2023 created SHA to replace the National Hospital Insurance Fund (NHIF). SHA runs three funds: the Primary Health Care Fund, the Social Health Insurance Fund, and the Emergency, Chronic and Critical Illness Fund.
Registration is mandatory for all residents, and contributions rise with household income. Khusoko explained the design when it launched in November 2023 and examined fraud and public trust in the scheme in August 2025.
Who has registered
The survey asked women aged 15 to 49 about SHA directly. Of those women, 42% said they are registered. Most found sign up simple: 16% called it very easy and 60% easy. Another 11% found it difficult and 3% very difficult.
Registration rises with age, from 22% among girls aged 15 to 19 to 52% among women aged 30 to 34. Schooling shows the same pattern. Among women with no education, 24% are registered. Among women with education beyond secondary school, 60% are.
County results range from 14% in Isiolo to 68% in Taita Taveta. KNBS notes that the lowest rates cluster in the arid and semi arid north, in Isiolo, Garissa, Tana River and West Pokot.
Why women stay out
Fifty eight percent of women are not registered. Cost leads the list of reasons, and documents come next.
| Reason for not registering | Share of unregistered women |
|---|---|
| Registration is too expensive | 37% |
| Problems with documents or inadequate cover for needed services | 24% |
| No interest, or satisfied with other cover | 17% |
The reasons shift with age. Among girls aged 15 to 19, 40% cite documents or inadequate cover. Among women aged 30 to 49, 42% to 50% cite cost. Where a woman lives changes the reason more than the rate. The share not registered is nearly the same in urban areas (58%) and rural areas (59%), yet 31% of unregistered rural women cite documents or inadequate cover, against 15% of urban women.
Schooling changes the rate. Among women with no education, 76% are not registered, against 40% among women with education beyond secondary school. Lack of awareness explains 22% of non registration among women with no schooling and 3% among the most educated.
What registered women use
Of registered women, 53% used SHA services in the 12 months before the survey. Use runs from 44% among girls aged 15 to 19 to 56% among women aged 20 to 24. Women who last sought care at a public facility reported SHA use at 58%, against 44% at private facilities and 42% at faith based or nongovernmental facilities. County use ranges from 35% in Bungoma to 77% in Elgeyo Marakwet.
Outpatient consultations account for most use, at 62%. Antenatal care follows at 9%, with delivery services and inpatient care at 8% each.
Most women met no obstacles, 73%. The other 27% reported problems: lack of medicine or supplies (9%), long waits (7%), the SHA system being down (7%) and inadequate benefits (6%). The problems differ by county. In Wajir, 42% of women with difficulties cited the system being down. In Kitui, 35% cited unpaid premiums and 30% cited missing medicine.
Women who used the cover reported results. Of them, 91% said it cut their out of pocket spending, 92% said they were satisfied, and 91% said they would recommend it.
Registration is not payment
SHA counts registrations differently from the survey. SHA chief executive Mercy Mwangangi told the National Assembly Health Committee that 32,180,494 people were registered as of 31 July 2026, or 67.7% of the population. About 5 million, roughly 15.5%, were actively contributing, according to Capital FM. Committee chair James Nyikal said: “Registration is not enough.”
The two sets of figures measure different things. The survey covers women aged 15 to 49 and asks if they are registered. SHA’s count covers all ages and counts sign ups, not payers.
What the figures show
Insurance reaches the counties with the most clinics and the highest incomes first. In Tana River and Isiolo, fewer than one in five people hold cover. The survey’s own reasons point to the fixes: lower costs for women aged 30 and over, simpler documents for girls and rural women, and a system that stays online.
