By Miraj Guo | 14th May 2026
The latest report on the Social Health Insurance Fund (SHIF) has revealed a sharp contrast between the illnesses that send most Kenyans to hospital and the conditions consuming the largest share of healthcare spending.
According to the facility payment report, high-volume illnesses such as respiratory infections and malaria account for the majority of processed claims but consume a relatively smaller portion of the health insurance budget. In contrast, specialized and chronic conditions continue to place immense pressure on the fund due to the high cost of treatment.
Maternal and obstetric care emerged as the single largest expenditure item under the scheme. Although maternal health services accounted for only 11.2 per cent of total claims, they consumed 18.9 per cent of overall SHIF spending.
The report also identified trauma and critical care services among the leading financial burdens on the scheme due to the expensive nature of emergency treatment and intensive care procedures.
Cancer treatment remains another major spending driver after the Social Health Authority (SHA) increased oncology coverage packages from Sh500,000 to Sh800,000 in a bid to cushion patients against rising therapy costs.
Kidney disease management also continues to stretch the fund, with thousands of dialysis sessions and kidney transplant procedures requiring heavy financial support from the national insurance scheme.
Despite these costly specialized treatments, respiratory illnesses remain the most common reason Kenyans seek medical care. Conditions such as pneumonia, bronchitis, coughs and throat infections accounted for 21.4 per cent of all processed claims.
However, the report noted that most upper respiratory infections are relatively inexpensive to treat and consumed only 4.1 per cent of the overall healthcare expenditure.
Malaria ranked as the third most frequent diagnosis, accounting for 9.8 per cent of claims and 6.7 per cent of total spending due to hospitalization and laboratory diagnostic costs.
The findings come amid growing concern over the long-term sustainability of the country’s universal healthcare financing model.
Data contained in the 2026 Economic Survey shows that SHIF collected Sh57.7 billion in premiums but incurred Sh91.5 billion in financial liabilities during the 2024–2025 financial year, exposing significant funding gaps and delayed hospital reimbursements.
Health experts warn that the increasing cost of chronic disease management and specialized care could continue straining the system unless additional financing and efficiency measures are introduced.
