What SHA Covers in Kenya: Full Benefits Package
What SHA covers is split across three separate funds by level of care: the Primary Healthcare Fund (PHF) for basic outpatient visits, the Social Health Insurance Fund (SHIF) for hospital admissions, surgery, maternity, cancer treatment, dialysis and specialist care, and the Emergency, Chronic and Critical Illness Fund (ECCIF) for emergencies, ICU care, and chronic conditions once SHIF’s limits are reached. Together, these cover everything from a routine clinic visit to major surgery — but only at facilities properly contracted for that specific service, and not everything is included.
Primary Healthcare Fund (PHF): basic outpatient care
The PHF covers your everyday, non-specialist healthcare needs at Level 2 to 4 facilities — dispensaries, health centres, and lower-level hospitals. It’s funded through government allocations and includes health education, consultation, diagnosis and treatment, prescribed lab investigations, basic radiological exams, drug dispensing, management of chronic and acute local conditions, screening, minor medical and surgical procedures (including male circumcision), immunization, and reproductive and maternal-child health services as defined by Ministry of Health guidelines.
| PHF Service | Access Point | Tariff |
|---|---|---|
| General outpatient care | Level 2–4 facilities | KES 900 per person, per year |
| Normal delivery (maternity) | Level 2–3 facilities | KES 11,200 |
| Caesarean section | Level 2–3 facilities | KES 32,600 |
| Cancer screening (HPV, PSA, occult blood) | Level 2–6 with capacity | KES 400–3,600 depending on test |
| Optical (consultation + eyeglasses, under-18s) | Level 2–3 facilities | KES 935, limit KES 1,000/household |
| Medical inpatient care | Level 3 facilities | KES 2,400/day, up to 50 days |
| End of life / mortuary services | Where available | KES 500/day, up to 5 days |
Social Health Insurance Fund (SHIF): the main insurance fund
SHIF is what replaced NHIF, and it’s the fund most people mean when they talk about “SHA cover.” It handles the bulk of hospital-based care at Level 4 to 6 facilities — inpatient admission, surgery, maternity at higher-level facilities, cancer treatment, dialysis, mental health care, imaging, and pharmacy benefits for chronic conditions.
| SHIF Service | Access Point | Tariff |
|---|---|---|
| Outpatient care (fixed fee) | Level 4–6 | KES 2,000, limit 4 visits/year |
| Medical inpatient care | Level 4–6 | KES 3,500–5,000/day by level, up to 50 days |
| Normal delivery / C-section | Level 4–6 | KES 11,200 / KES 32,600 |
| Hemodialysis / hemodiafiltration | Level 4–6, dialysis centre | KES 10,650 per session |
| Peritoneal dialysis | Level 4–6 | KES 180,000/month, capped 12 sessions/year |
| Mental health outpatient | Level 3–6 | KES 1,200/visit, up to 7 visits |
| Surgical services | Level 3–6 | Fee-for-service, tariffs annexed per procedure |
| Chemotherapy administration | Level 4–6 | KES 5,000 |
| MRI / CT scan | Facilities with imaging services | KES 11,000 / KES 9,600 |
| Chronic condition medication | Public, faith-based & community pharmacies | Quarterly limit KES 5,000/person |
For full tariff detail on the two highest-demand SHIF services, see our dedicated guides on SHA dialysis cover and SHA cancer treatment cover.
Emergency, Chronic and Critical Illness Fund (ECCIF)
ECCIF steps in for the most severe cases — genuine emergencies, ICU-level critical care, and chronic conditions that continue beyond what SHIF alone covers. This isn’t a richer, separate benefit you apply for; it’s the fund that keeps paying for paid-up SHIF members once care crosses into this territory.
| ECCIF Service | Access Point | Tariff |
|---|---|---|
| Ambulance evacuation | All Kenyans | Up to KES 4,500 (25km), KES 75/km beyond |
| Accident & Emergency (resuscitation, trauma, stroke, etc.) | Level 2–6 | Fee-for-service up to set limits per condition |
| ICU / HDU critical care | Level 4–6 | KES 35,000 / KES 10,000 per day |
| Palliative care | Level 4–6 | KES 5,000/day, up to 60 days |
| Chronic illness management beyond SHIF limit | Level 4–6, paid-up members | Same tariffs as SHIF |
| Assistive devices (hearing aids, crutches, walking frames) | Level 4–6 | KES 500–55,000 depending on device |
Emergency care specifically comes with a strong protection: SHA has stated that no patient requiring emergency treatment should be turned away for inability to pay or lack of benefit confirmation. If this has happened to you, see our guide on what to do when a hospital refuses SHA.
Can SHA be used in any hospital?
No. SHA can only be used at facilities actively contracted for the specific service you need — and contracting is granular. A hospital might be contracted for general inpatient care but not for dialysis, or for surgery but not for a specific specialized oncology procedure. Basic outpatient PHF services are widely available at Level 2–4 facilities; most of what’s described above under SHIF and ECCIF requires Level 4–6 facilities with the right equipment, specialist staff, and active SHA contract for that exact service. Always confirm directly with the facility’s SHA desk before assuming a service is covered there.
What SHA does not cover
The items below are commonly reported as excluded from SHA cover, but they are not spelled out in full detail in the primary Benefits Package document reviewed for this page. Treat this as a general guide, and confirm anything specific to your situation directly with SHA or your facility before assuming it is or isn’t covered.
Cosmetic procedures and purely aesthetic beauty treatments.
Non-medical massage therapy and herbal treatments outside conventional medical care.
Self-prescribed medication and treatment obtained through unauthorized referrals.
Experimental treatments not part of standard clinical practice.
Elective laser eye surgery.
FAQ: What SHA Covers
What does SHA cover in Kenya?
SHA covers outpatient consultations, laboratory tests, hospital admissions, surgery, maternity care, cancer treatment, dialysis, mental health care, and emergency and critical care, split across three funds: the Primary Healthcare Fund, the Social Health Insurance Fund, and the Emergency, Chronic and Critical Illness Fund.
How many types of SHA cover are there?
There are three funds under SHA: the Primary Healthcare Fund (PHF) for basic outpatient care, the Social Health Insurance Fund (SHIF) for the main range of inpatient, surgical, maternity and specialist care, and the Emergency, Chronic and Critical Illness Fund (ECCIF) for emergencies, ICU care, and chronic conditions that go beyond the SHIF limit.
Can I use SHA in any hospital?
No. You can only use SHA at facilities that are actively contracted with SHA for the specific service you need. Basic outpatient care is available at Level 2 to 4 facilities, while inpatient care, surgery, maternity, cancer treatment, and dialysis are generally restricted to Level 4 to 6 facilities with the right contracting and equipment.
How much does SHA pay for surgery?
SHA pays for surgery on a fee-for-service basis with tariffs set per procedure under the Surgical Services Package, available at Level 3 to 6 facilities. Minor procedures at Level 2 to 3 facilities are funded through the Primary Healthcare Fund instead, while emergency and palliative surgery are paid under ECCIF.
Does SHA cover dental treatment?
SHA’s published benefits package does not list a dedicated dental package. Some reports describe limited dental cover such as extractions, scaling and infection management being offered at certain facilities, but this is not confirmed in the primary Benefits Package document, so confirm directly with your facility or SHA before assuming dental treatment is covered.
What is not covered by SHA?
Commonly reported exclusions include cosmetic procedures and beauty treatments, non-medical massage and herbal treatments, self-prescribed medication and unauthorized referrals, experimental treatments, and elective laser eye surgery. Confirm specific exclusions with SHA directly, as this list is not exhaustively detailed in the primary Benefits Package.
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