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What SHA actually covers in Kenya (2026): the three funds explained

SHA runs three funds: PHF for primary care, SHIF for secondary and tertiary care, and ECCIF for emergency, chronic and critical illness. Fund-by-fund coverage, tariffs, and exclusions.

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

One scheme, three funds

When people ask "does SHA cover X?" the answer depends on which of the three SHA funds the service falls under. The Social Health Insurance Act 2023 established three funds under the Social Health Authority, each with its own scope, tariff schedule, and financing model. All three sit inside the umbrella SHA scheme, so a single member with an active registration can draw on any of them depending on the service.

Understanding the split matters because it determines where you go for care, what the hospital bills, and where the co-pay lands. It also determines what to expect on the ledger. A dispensary visit does not bill SHIF; an ICU admission does not bill PHF. Getting this right stops the arguments at admission.

Primary Healthcare Fund (PHF)

The PHF finances everyday primary care at Level 2 (dispensaries) and Level 3 (health centres), with a small overlap into select Level 4 primary referral facilities. It is government-funded through the exchequer; members do not pay a premium into PHF directly [Source 1].

Per SHA's published benefit tariffs [Source 4], PHF covers:

  • Outpatient care. Consultation, diagnosis, treatment, basic laboratory tests and X-rays, prescription processing, drug administration, health education, management of non-communicable diseases, HIV, STIs, immunisation on the KEPI schedule, and reproductive, maternal, and child health services. Funded through a global-budget capitation of KES 900 per person per annum, distributed monthly based on visits.
  • Antenatal and postnatal care. ANC and PNC are covered under the outpatient package at Levels 2, 3, and select Level 4 primary referral facilities.
  • Cancer screening. Screening for breast, cervical, prostate, and colon cancer. Specific tariffs: HPV screening KES 3,600, PSA test KES 1,500, stool for occult blood KES 400, cryotherapy KES 3,000, thermal ablation KES 3,000, LEEP KES 2,800.
  • Optical health. Eye tests and dispensing of prescription glasses. KES 950 for eyeglasses, limit KES 1,000 per household per annum. Refractive-error treatment initially limited to under-18s.
  • End-of-life services. Embalming KES 3,000, mortuary storage KES 500 per day for 5 days, subject to budgetary allocation.
  • Basic delivery at Level 2 and 3. Normal delivery and essential newborn care KES 10,000; caesarean section and essential newborn care KES 30,000. Free at point of care for registered beneficiaries.

Social Health Insurance Fund (SHIF)

SHIF is the fund most people think of when they hear "SHA contributions", because the 2.75% member contribution goes here. It finances secondary and tertiary hospital care at Levels 4 (county referral), 5 (county tertiary), and 6 (national referral) [Source 2]. Some services are also accessible at Level 3.

SHIF coverage per published tariffs [Source 4]:

  • Inpatient bed-day. Level 3 KES 2,240, Level 4 KES 3,360, Level 5 KES 3,920, Level 6 KES 4,480. Limit 180 days per household per annum.
  • Maternity at Level 2 to 6. Normal delivery KES 10,000, C-section KES 30,000, Anti-D serum KES 6,000. See SHA for maternity in Kenya.
  • Renal care. Haemodialysis and haemodiafiltration KES 10,650 per session, 2 sessions per week. Peritoneal dialysis KES 85,200 per month, 12 monthly sessions. Kidney transplant recipient surgery KES 700,000. See SHA for kidney dialysis.
  • Oncology. Chemotherapy, radiotherapy, hormonal and immunotherapy. Annual limit KES 400,000 per person for diagnosis, staging and treatment. Sub-tariffs: chemo administration up to KES 5,500, radiotherapy KES 3,600 per session up to 30 sessions, PET scan KES 53,500. See SHA for cancer treatment.
  • Surgical package. Minor, major and specialised procedures. 3 minor, 2 major, 1 specialised procedure per household per year. See SHA for surgery in Kenya.
  • Medical imaging. MRI KES 11,000, CT KES 6,900, mammography KES 3,000, echocardiogram KES 3,500, EEG KES 5,000 (adult). Limit 2 per imaging type per household per annum.
  • Mental wellness. Inpatient at bed-day tariff; drug and substance abuse rehab KES 67,200.
  • Overseas treatment. Where the procedure is not locally available, limit KES 500,000 per person per annum per Regulation 39.
  • Oral health. Extractions, ART, scaling and polishing, herpetic wound cleaning. Limit KES 2,000 per household per annum.

Emergency, Chronic and Critical Illness Fund (ECCIF)

ECCIF is the fund that catches the events people cannot plan for. Per SHA [Source 3], it covers:

  • Ambulance evacuation. 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 life-threatening conditions.
  • Palliative care. Pain management, psychological support, caregiver assistance, end-of-life care for chronic illnesses.
  • Chronic illness management. Diabetes, cancer, mental health conditions including neurodevelopmental and psychoactive disorders.

Two ECCIF properties matter more than any tariff: emergency care under ECCIF is available regardless of active contribution status (a hospital cannot legally refuse emergency care because your SHA is in arrears), and ECCIF is publicly funded, not from member premiums. See SHA emergency care and SHA for chronic and emergency conditions.

What SHA does not cover

The benefit tariffs document lists 20 general exclusions [Source 4]. The ones members hit most often:

  • Cosmetic procedures and any complications from them (unless in the surgical schedule).
  • Assisted fertility including IVF.
  • Chiropractic, acupuncture, herbal treatment.
  • Vaccines outside KEPI.
  • Drugs outside the Kenya Essential Medicines List.
  • Weight management drugs and nutritional supplements.
  • Private-ward-only admissions and stays at sanatoria, health spas, or nature-cure clinics.
  • Costs from clinical trials or research.
  • Hormone replacement therapy except immediately post-authorised surgery.
  • Any procedure not listed in the benefit package for the relevant facility level.

Public vs private facilities

Public Level 2 to 6 facilities are contracted by default and bill SHA directly at the published tariffs. Faith-based hospitals (Nazareth, Kikuyu Mission, PCEA Kikuyu, AIC Kijabe, and others) are widely contracted. Private hospitals contract individually with SHA and often charge above tariff; the difference is your co-pay. See SHA and private hospitals: what you may still owe. For the authoritative live list, use sha.go.ke/contracted-facilities or eligibility.sha.go.ke.

Inpatient vs outpatient

Outpatient is largely PHF territory. Inpatient is SHIF (elective admission) or ECCIF (ICU / critical). A visit to your local clinic for consultation and drugs is outpatient PHF, funded through the capitation model with no bill to you. An admission for pneumonia at a county hospital is SHIF inpatient at the bed-day tariff. An ICU admission for the same pneumonia crossing over to sepsis is ECCIF critical illness care.

Paying in and checking status

Contributions are paid via Paybill 200222, account = National ID. Use the SHA contribution calculator to work out your monthly amount, and see the SHA paybill reference for the full payment steps. Check your coverage status via afyayangu.go.ke or dial *147#. If a payment does not show up, follow SHA payment not reflecting.

Sources

  1. SHA Primary Healthcare Fund: sha.go.ke/primary-healthcare-fund, accessed 26 August 2026.
  2. SHA Social Health Insurance Fund: sha.go.ke/social-health-insurance-fund, accessed 26 August 2026.
  3. SHA Emergency, Chronic and Critical Illness Fund: sha.go.ke/emergency-chronic-critical-illness-fund, accessed 26 August 2026.
  4. SHA benefit tariffs: sha.go.ke/benefit-tariffs, accessed 26 August 2026.
  5. Social Health Insurance Act 2023, establishing the three funds.
  6. SHA contracted facilities: sha.go.ke/contracted-facilities, accessed 26 August 2026.