Uptake of health insurance under the Social Health Authority (SHA) is highest among Kenyans aged 65 and above, signaling a scramble by the age group hardest hit by out-of-pocket (OOP) expenditures alongside people affected by chronic conditions.
Newly published data from the Kenya National Bureau of Statistics show that 46.6 percent of Kenyans aged 65 and above have health insurance under SHA, the highest level among all age sets.
A recent World Bank study said OOP expenditures continue to make up a significant share of total health spending in Kenya, pushing about one million individuals into poverty each year.
The multilateral lender said OOP mainly hurts households from disadvantaged socioeconomic backgrounds-explaining the high uptake of SHA cover in the age group of 65 and above, which includes retirees with little or no income at all.
SHA, which was established under the Social Health Insurance Act, 2023 (Republic of Kenya 2023) to replace the National Hospital Insurance Fund, manages three funds-the Primary Health Care Fund; the Social Health Insurance Fund (SHIF); and the Emergency, Chronic and Critical Illness Fund-to provide all households with affordable, equitable, and quality health care.
Uptake among the economically active population came second, with 41.4 percent of those between 15-64 years having taken SHA, according to the findings of the Kenya Mini Demographic and Health Survey (KMDHS) 2025-26.
The KMDHS 2025-26 findings further show that, generally, uptake of SHA across the country was 39.4 percent, with the lowest uptake being in children aged 14 at 35.3 percent.
‘Nationally, 40 percent of the household population has some form of health insurance, with most insured households covered under the Social Health Authority,’ said the KNBS in the report.
Health coverage plays a crucial role in cushioning households from OOP health care expenditures, which are costly, especially in times of high inflation.
The survey findings also revealed a slight gender gap in SHA, with uptake among men reported at 37.4 percent compared to 41.4 percent among women.
Among women who used SHA services in the 12 months before the survey, 91 percent reported reduced OOP spending as a benefit, while 22 percent mentioned reduced stress over health expenses.
Urban dwellers reported higher health cover uptake compared to their counterparts in rural areas, mainly due to wealth disparities between the two demographics.
The gap in insurance coverage was also evident across income groups. Only 24 percent of people in the poorest households had health insurance, compared to 52 percent in the wealthiest group. While 43.9 percent of urban residents had health insurance, coverage in rural areas stood at 38 percent.
At 39.4 percent, SHA accounted for the largest share of those who had health cover. This was mainly due to the mandatory requirement for those in formal employment.
Those who primarily depend on private medical cover represent 1.1 percent of those insured.