My biggest concern with the transition from NHIF to SHA has always been the harm caused along the way—particularly to healthcare professionals and healthcare facilities.
As the government promotes the successes of SHA, especially in the political arena, we must also have an honest conversation about those who have carried the cost of this transition.
Healthcare providers treated patients in good faith. They employed doctors, nurses, pharmacists, laboratory personnel and other workers. They bought medicines and supplies. They paid rent, electricity, taxes and salaries—often on the understanding that money legitimately owed to them would eventually be reimbursed.
For many, that money did not come when it was needed.
The consequences have been substantial:
1. Unpaid legacy NHIF debts, some stretching back many years. Even in September 2026, the government continues to reconcile and settle inherited NHIF obligations.
2. Accumulating SHA claims and delayed reimbursements. Government reports significant payments under SHA, while healthcare providers continue to report substantial outstanding claims. These two realities need to be transparently reconciled.
3. Financial distress and closure of healthcare facilities. Indeed, the Health Cabinet Secretary has himself acknowledged that delayed payments can push facilities towards closure.
4. Reputational damage to healthcare professionals and facilities accused or suspected of fraud. Fraud must certainly be investigated and prosecuted where evidence exists. But suspected fraud by some providers should never become collective condemnation of an entire profession or sector. Due process, individual responsibility and the presumption of innocence matter.
5. A benefits package whose exclusions and tariff limitations can leave significant healthcare costs uncovered, particularly for patients requiring expensive, long-term or specialised treatment.
If our destination is Universal Health Coverage, we should continually ask not merely how many people are registered, but how much of the healthcare they actually need is covered.
6. Rejection or return of legitimate claims because of documentation, coding or other administrative deficiencies. Accountability is necessary, but administrative imperfections should have proportionate remedies. A correctable clerical error should not automatically translate into loss of payment for healthcare already legitimately provided.
So perhaps the next conversation Kenya needs to have is about restorative justice in healthcare.
Restorative justice begins by acknowledging that harm occurred.
It then asks: Who was harmed? What did they lose? Who bears responsibility? And what must be done to repair that harm and prevent it from happening again?
For healthcare professionals and facilities affected by the NHIF-to-SHA transition, restorative justice could mean:
1. Paying every verified legitimate NHIF and SHA debt, with a transparent reconciliation process and clear timelines.
2. Compensating providers for unreasonable payment delays, because a debt that remains unpaid for years has a real cost—interest, lost investment, unpaid salaries and, sometimes, closure of a healthcare facility.
3. Creating a fair, independent claims appeals mechanism so that a clerical or coding error can be corrected without automatically extinguishing an otherwise legitimate claim.
4. Restoring reputations where accusations of fraud were made but not substantiated, while firmly prosecuting actual fraud where evidence establishes wrongdoing.
5. Reviewing tariffs and exclusions with patients and healthcare providers at the table, so that SHA progressively moves Kenya closer to comprehensive UHC rather than merely increasing registration numbers.
6. Publishing transparent data showing claims submitted, approved, rejected, returned, paid and outstanding—and the reasons for rejection.
7. And finally, giving healthcare professionals and facilities a meaningful voice in redesigning the system. Those who provide healthcare every day should not merely be recipients of policy; they should be partners in developing it.
Restorative justice is not about returning to NHIF.
Neither is it about pretending that SHA has achieved nothing.
It is about recognising that health reforms should not create casualties among the very people and institutions expected to deliver healthcare.
– If harm was caused during the transition, that harm deserves acknowledgement.
– If money is legitimately owed, it should be paid.
– If reputations were unfairly damaged, they should be restored.
– If the system has weaknesses, they should be corrected.
And if we truly want Universal Health Coverage, then we must protect not only the patient seeking healthcare, but also the healthcare workers and facilities upon whom that promise depends.
That would be restorative justice in health.
Dr Simon Kigondu is a gynaecologist and a human rights defender.