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SHA for chronic and emergency conditions in Kenya: the ECCIF fund explained (2026)

ECCIF is the SHA fund for emergencies, critical illness, and chronic disease management. What it covers, how it differs from SHIF, why emergency care is guaranteed regardless of contribution status.

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by Reviewed by Michael Mwangi 12 min read Updated 26 August 2026Verified 26 Aug 2026

One of three SHA funds

SHA runs three funds under the Social Health Insurance Act 2023: PHF (Primary Healthcare Fund) for outpatient and primary care at Levels 2 and 3, SHIF (Social Health Insurance Fund) for secondary and tertiary care at Levels 3 to 6, and ECCIF (Emergency, Chronic and Critical Illness Fund) for emergency, critical, and chronic conditions. Members do not opt into individual funds; the fund is determined by the service. Full breakdown: what SHA actually covers.

ECCIF vs SHIF: what falls where

The distinction matters because it determines whether your active contribution status affects your access, and where the hospital claim goes.

  • SHIF pays for planned admission, elective surgery, deliveries, oncology visits within the annual limit, dialysis sessions, imaging, and specialist consults. Requires active SHA status. Financed by the 2.75% member contribution and other SHIF revenue.
  • ECCIF pays for the emergency-escalation portion of any admission (ICU, HDU, NICU, PICU, burns unit), ambulance evacuation, and the ongoing chronic-illness management for diabetes, cancer, and mental health. Emergency access does not depend on active status. Financed publicly, not by member premiums [Source 1].

A worked example: a member with a diabetic ketoacidosis crisis is rushed to a county referral hospital. The ambulance leg bills ECCIF. The initial ICU stabilisation bills ECCIF. Once stable and moved to a ward for further inpatient management, the bed-day charges bill SHIF (subject to active status). Discharge home with insulin and monitoring falls back to ECCIF chronic-illness management. One episode, three fund touchpoints.

What ECCIF covers, per SHA

Per SHA's published fund page [Source 1]:

  • Ambulance evacuation. Timely transport from the incident location to the nearest medical facility.
  • Accident and emergency services. Severe burns, head injuries, fractures, seizures, unconsciousness, snake bites, rabies.
  • Critical illness care. ICU, HDU, NICU, PICU, and burns unit admissions for patients with life-threatening conditions.
  • Palliative care services. Pain management, psychological support, caregiver assistance, and end-of-life care for chronic illnesses.
  • Chronic illnesses. Treatment for diabetes, cancer, and mental health conditions, including neurodevelopmental and psychoactive disorders.

Chronic illness cover: what is actually paid

SHA's ECCIF page names the conditions (diabetes, cancer, mental health). The line-item tariffs (which drugs, at what price, with what monthly limit) live in the benefit tariffs document [Source 2] and are subject to change. Cancer, for example, has a KES 400,000 annual limit per person for diagnosis, staging, and treatment under SHIF, with specific sub-tariffs for chemotherapy, radiotherapy, and imaging. Dialysis, chronic diabetes management, chronic mental-health medication, and other long-course therapies each have their own sub-tariffs and, in most cases, pre-authorisation requirements.

Because specific drug lists and monthly caps do change and are not always mirrored across SHA information pages, the reliable per-condition answer is a call to 0800 720 601 with your SHA number and the drug or procedure name. Where SHA has not published a specific line item we mark it unverified rather than restating from secondary sources. See the condition-specific guides in the SHA cluster as they land.

Pre-authorisation for chronic care

Chronic-illness pathways (oncology cycles, dialysis series, chronic mental-health prescriptions, insulin regimes) typically require pre-authorisation by SHA before the facility can bill. This is a claims-integrity mechanism, tightened after the fraud enforcement of late 2024 and early 2025 (KES 11 billion lost, 31 facilities closed, nine arrests including a former CEO, per reported figures). Practically:

  • Ask your treating facility to confirm pre-authorisation is in place before each cycle or prescription.
  • Retain the authorisation reference number.
  • If pre-authorisation is refused, ask for the reason in writing; this is what an appeal is built on. See how to appeal a rejected SHA claim.

Emergency care mechanics: no arrears block

The single most important operational rule under ECCIF: emergency care under ECCIF is available regardless of active SHA contribution status. A hospital that refuses emergency care citing SHA arrears is acting outside SHA's stated rules. If refusal occurs:

  1. Insist on emergency admission under ECCIF and cite ECCIF by name.
  2. Ask the admissions clerk to phone 0800 720 601 in your presence.
  3. Escalate to the hospital administrator on duty.
  4. Document names, times, and rejection reasons. Take a photo of any eligibility-portal error message.
  5. File a formal complaint with SHA and, if the patient is harmed, retain counsel.

Full escalation playbook: what to do when a hospital refuses SHA.

Where co-pays still apply

ECCIF covers the emergency and chronic scopes above at the SHA tariff. Where a facility charges above the SHA tariff (typical in private hospitals), the difference is a member co-pay. Where a service is outside the SHA benefit package (a drug not on the Essential Medicines List, a private-ward-only admission), it is not covered at all and is billed to the member. This is why an ICU admission at a top-tier private hospital can generate a large co-pay even though ECCIF covered the SHA-tariff portion of the ICU care. See SHA and private hospitals: what you may still owe.

If your condition is not explicitly listed

ECCIF names diabetes, cancer, and mental health explicitly, alongside a broad emergency scope. Many chronic conditions (hypertension, HIV, sickle cell, epilepsy) sit primarily under PHF outpatient care with certain complications escalating to SHIF or ECCIF. HIV in particular has separate NASCOP-managed programmes that continue alongside SHA cover. If your specific condition is not named on the ECCIF page, before assuming exclusion:

  • Check the SHA benefit tariffs for the specific condition code.
  • Phone 0800 720 601.
  • Ask your treating clinician which SHA benefit code they intend to bill under.

How to use ECCIF well, in practice

  • For chronic conditions, register with your primary care network at a Level 3 or 4 facility and get on their chronic care register. Regular reviews are easier under a maintained relationship than at first presentation.
  • For cancer or dialysis, request the treatment plan and the SHA pre-authorisation reference in writing at the start of each cycle.
  • Save 0800 720 601 in your phone and keep a photo of your SHA member card, National ID, and eligibility status.
  • If in doubt at a facility, ask "is this being billed under ECCIF, SHIF, or PHF?" The answer tells you what the rules and any co-pay look like.

Sources

  1. SHA Emergency, Chronic and Critical Illness Fund: sha.go.ke/emergency-chronic-critical-illness-fund, accessed 26 August 2026. Scope quoted: ambulance evacuation, accident and emergency services, critical illness care (ICU/HDU/NICU/PICU/burns), palliative care, chronic illness management (diabetes, cancer, mental health).
  2. SHA benefit tariffs: sha.go.ke/benefit-tariffs, accessed 26 August 2026.
  3. SHA Social Health Insurance Fund: sha.go.ke/social-health-insurance-fund, accessed 26 August 2026.
  4. Social Health Insurance Act 2023 establishing the three-fund scheme.
  5. SHA toll-free helpline 0800 720 601.
  6. Public reporting on SHA fraud enforcement (KES 11 billion lost October 2024 to April 2025, 31 facilities closed, nine arrests including a former CEO). Attribute to source when citing.