Healthcare in Kenya for Expats: What SHA Covers and What It Does Not

KENYA · HEALTHCARE

Kenya replaced its national health insurance scheme two years ago. For a foreign resident, the practical consequence is that private insurance matters more than it did, not less.

Kenya has good private hospitals. It also has a public system in the middle of the largest reform in its history. A foreign resident has to bridge the gap between the two with insurance.

Where This Fits

Kenya is rebuilding how it pays for healthcare from the ground up. It is doing so while the new system is still working out arrears with the hospitals it depends on. A foreign resident is arriving in the middle of that transition, not after it.

That timing matters. A scheme still stabilising its own finances is not the scheme to rely on for a serious medical bill. Private insurance exists precisely to sit outside that uncertainty.

What Replaced the Old Scheme

The National Hospital Insurance Fund was established in 1966. It was replaced on 1 October 2024 by the Social Health Authority, under the Social Health Insurance Act of 2023. The consumer-facing brand is Taifa Care.

The authority administers three funds. The Primary Healthcare Fund covers outpatient care at lower-level facilities and is financed from the exchequer. The Social Health Insurance Fund covers inpatient medical care, maternity, renal, mental health and surgical services. It is financed by member contributions. The Emergency, Chronic and Critical Illness Fund covers ambulance and evacuation, accident and emergency, critical illness, palliative care. Chronic disease beyond the second fund’s limits. It is government financed.

What It Costs to Belong

Formal-sector members contribute 2.75% of gross monthly pay. The minimum is 300 shillings a month, about US$2.32, and there is no upper cap. On a salary of 50,000 shillings that is 1,375 shillings a month, about US$10.62. On 100,000 shillings it is 2,750, about US$21.25.

Informal-sector and non-salaried members are means-tested against the same 300-shilling floor, with an instalment facility. Reporting differs on whether the 2.75% is employee-only or matched by the employer. The Rio Times does not state which.

Registration is open to all residents, including non-citizens, who register with an alien identity card. The authority states there are no age limits. There are also no exclusions for pre-existing conditions and no cap on dependants. Whether contribution is enforceable against a foreign retiree with no Kenyan payroll is not cleanly settled in public sources.

What the Scheme Actually Pays

The tariffs published in February 2026 set the terms precisely. Outpatient primary care is 900 shillings per person a year, about US$6.95. Medical inpatient care pays 2,240 to 4,480 shillings a day depending on facility level, about US$17 to US$35. It is capped at 180 days per household a year.

Maternity pays 10,000 shillings for a normal delivery, about US$77, and 30,000 for a caesarean, about US$232. Dialysis pays 10,650 a session for two sessions a week. Oncology is capped at 400,000 shillings per person a year, about US$3,090. A further 400,000 is available from the emergency fund once that is exhausted.

Critical care at the higher facility levels pays 28,000 shillings a day, about US$216, for twelve days. Prior authorisation is required after that. Ambulance cover pays 4,500 shillings within 25 kilometres and 75 a kilometre beyond. It is available to all Kenyans regardless of registration or payment status.

The Exclusion That Decides It for Expats

The scheme explicitly excludes private ward admissions, luxury services and personal comfort items. It also excludes cosmetic procedures unless medically necessary, assisted fertility treatment and vaccines outside the national schedule.

That single exclusion is why a foreign resident still needs private insurance. The scheme will not pay for the accommodation, and frequently not the institution, that most expatriates would choose.

The arithmetic is starker on maternity. A normal delivery at Aga Khan University Hospital costs about 120,000 shillings, and a caesarean about 220,000. The scheme pays 10,000 and 30,000. It covers roughly a tenth of the bill.

The System Is Under Strain

By September 2026 the authority reported 32.3 million registered members. Only about five million were actually paying premiums to July. That produced 203.7 billion shillings collected against 178.4 billion paid out.

Hospital arrears stood at 11 billion shillings, about US$85 million. The health ministry had rejected 10.6 billion shillings of claims as fraudulent. Earlier in 2026 the private hospitals association reported members receiving only 54% of filed claim value. Thousands of beds were removed from the registry, and hospitals threatened to move to cash-only operation.

The practical consequence for a foreign resident is simple. A growing number of private hospitals decline the scheme and ask for cash or a private policy at the door.

The Private Hospitals

In Nairobi the established institutions are Aga Khan University Hospital. This treats patients from more than 27 African countries, along with The Nairobi Hospital, MP Shah, The Karen Hospital, The Mater and Avenue Healthcare. Kenyatta National Hospital is the main public referral centre.

In Mombasa the Aga Khan Hospital was recently upgraded to serve a catchment of 1.2 million. Mombasa Hospital, Pandya Memorial and the Coast General referral hospital are also established there.

A private specialist consultation in Nairobi costs 3,000 to 10,000 shillings, about US$23 to US$77. The Nairobi Hospital charges 4,000 to 5,000. In smaller towns the range is 1,500 to 3,000. An MRI starts from about 8,500 shillings, roughly US$66, depending on the region scanned and whether contrast is used.

Private Insurance

Annual premiums start from about 8,900 shillings, roughly US$69, on budget tiers from APA. AAR’s entry price is 16,361 shillings, about US$126. Jubilee’s main product, which holds roughly a sixth of the market, is 21,316 shillings, about US$165. Old Mutual’s plan including critical illness is 32,257 shillings, about US$249.

Those are entry prices for younger members. Premiums rise steeply with age and with the inpatient limit chosen. A foreigner in their sixties should expect a multiple of the entry figure. An international policy may be the better option.

The question to ask any Kenyan insurer is which hospitals it settles with directly. A policy that reimburses after the fact is a different product from one that admits you without payment.

Practical Health Matters

Malaria is present at the coast and around Lake Victoria. It is largely absent from Nairobi, which sits at about 1,795 metres. Prophylaxis depends on where you live and travel rather than on being in Kenya.

Yellow fever vaccination is required for entry from certain countries, and is worth holding regardless for regional travel. Private air and road ambulance services operate from Nairobi. That is why evacuation cover is worth having if you live outside the capital.

What This Means for an Expat

Treat the Social Health Authority as a genuine backstop, not as your health insurance. It is real cover, it is open to you, and it is worth registering for. It is not built to pay for the hospital room or the delivery suite most expatriates would choose.

Budget for private insurance as the primary policy, and the state scheme as a supplement. That is the reverse of how many arrivals assume it works. Check which hospitals your insurer settles with directly, before you need to find out the hard way.

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Frequently Asked Questions

What replaced Kenya’s national health insurance fund?

The Social Health Authority, from 1 October 2024, administering three funds under the Social Health Insurance Act of 2023.

Can foreigners register?

Yes. Registration is open to all residents including non-citizens, using an alien identity card, with no age limits or pre-existing condition exclusions.

How much are contributions?

2.75% of gross monthly pay in the formal sector. It comes with a floor of 300 shillings a month, about US$2.32, and no upper cap.

Does the scheme cover private hospitals?

It excludes private ward admissions and luxury services, and a growing number of private hospitals decline it because of payment arrears.

What does it pay for a delivery?

10,000 shillings for a normal delivery and 30,000 for a caesarean, against private hospital charges of 95,000 to 220,000.

What does private insurance cost?

Entry-level annual premiums start from about 8,900 shillings, roughly US$69, and rise steeply with age and coverage limits.

Sources: Social Health Authority, Ministry of Health tariff regulatory impact assessment 2026, The Standard, Nation Africa, Rural and Urban Private Hospitals Association.