Kenya’s Social Health Insurance Fund (SHIF) is channelling billions of shillings into healthcare across the country, but new payment data reveals a system of sharp contrasts, where a handful of referral hospitals collect enormous sums while many smaller facilities receive next to nothing. 

The pattern that emerges is one of concentration rather than spread. A small cluster of counties, home to national referral hospitals, teaching institutions and specialist private facilities, absorbs a disproportionate share of SHIF payments, while counties without such infrastructure are left dependent on primary care services that generate comparatively little reimbursement.  

This is not simply a reflection of where Kenyans live, but of where advanced medical care is available, meaning the fund’s disbursements trace the geography of specialist healthcare rather than the geography of population. 

That concentration carries real consequences for how Kenyans experience the health system. Patients outside these hospital-rich counties are effectively dependent on travelling long distances to access the specialist care that drives higher reimbursements, a pattern that risks entrenching regional inequality even as SHIF aims to expand coverage nationwide.  

It also means the fund’s overall health, and the sustainability of Universal Health Coverage (UHC), is closely tied to the performance of a small number of referral hospitals rather than being spread evenly across the country’s health infrastructure. 

Three counties, Nairobi, Uasin Gishu and Kiambu accounted for more than a third of all SHIF payments  

An analysis of SHIF payment records covering July 2025 to April 2026 shows the fund disbursed Ksh65.42 billion to 4,718 public and private facilities across all 47 counties, averaging Ksh13.87 million per facility. Payments ranged from Ksh1.70 billion for the country’s top earner to as little as Ksh2,240 for its smallest recipients, a gap that lays bare how concentrated SHIF reimbursements are around specialised, complex care. 

 Just three counties, Nairobi, Uasin Gishu and Kiambu, together accounted for more than a third of all SHIF payments nationally, underlining how tightly concentrated the fund’s disbursements are around a small cluster of hospital-rich regions. 

The figures reflect Kenya’s broader health infrastructure. Counties with national referral hospitals, teaching institutions and specialist private hospitals dominate SHIF payouts, while counties with smaller health centres and dispensaries receive far less. What drives the payments is the complexity of care provided, patient volumes and the availability of specialist services, rather than population size alone. 

Moi Teaching and Referral Hospital (MTRH) in Uasin Gishu County tops the list, having received Ksh1.70 billion, the single largest SHIF payout during the period. As one of Kenya’s two principal referral hospitals outside Nairobi, it serves millions of people across western Kenya, the Rift Valley and neighbouring countries, offering specialised services such as renal care, oncology, cardiology, neurosurgery and intensive care, all of which attract higher SHIF reimbursement. 

Kenyatta National Hospital (KNH) comes second, with Ksh1.50 billion. As the country’s largest referral hospital and its final destination for the most complex medical cases, KNH manages thousands of admissions monthly and performs some of Kenya’s most specialised procedures, making it one of the biggest consumers of SHIF resources. 

Tenwek Hospital in Bomet County received Ksh1.08 billion, the fourth-highest SHIF beneficiary  

Kenyatta University Teaching, Referral and Research Hospital (KUTRRH) rounds out the top three, with Ksh1.24 billion. Though younger than KNH and Moi Teaching and Referral Hospital, KUTRRH has quickly become one of Kenya’s leading referral centres, particularly for cancer treatment, critical care and specialised surgery. 

Together, these three public referral hospitals received more than Ksh4.4 billion, almost seven per cent of all SHIF payments made nationally over the ten months. 

Among the data’s biggest surprises is the performance of Tenwek Hospital in Bomet County. The faith-based Level 5 hospital received Ksh1.08 billion, making it the fourth-highest SHIF beneficiary nationally and the highest-paid mission hospital, built on a long-standing reputation for specialist surgery, neurosurgery and complex medical care that draws patients from across East Africa. 

AIC Kijabe Hospital in Kiambu also features prominently, receiving Ksh878.57 million to rank sixth nationally. Between Tenwek and Kijabe, the figures show church-owned hospitals have become major providers of specialised healthcare, often matching or exceeding government facilities in patient volumes and complexity of care. 

Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu completes the top five, with Ksh919.76 million. It serves as the principal referral facility for western Kenya and has significantly expanded its specialist services in recent years. 

Nairobi County dominates SHIF payments with Ksh14.91 billion, nearly a quarter of all reimbursements 

The rest of the top ten is dominated by referral and specialist hospitals: Rift Valley Provincial General Hospital in Nakuru (Ksh646.15 million), Aga Khan University Hospital Nairobi (Ksh644.60 million), Coptic Hospital (Ksh580.43 million), The Nairobi Hospital (Ksh566.70 million), and Coast General Teaching and Referral Hospital (Ksh565.11 million). 

County rankings closely mirror where these facilities are located. Nairobi County dominates national SHIF payments, having received Ksh14.91 billion, nearly a quarter of all reimbursements made across Kenya. It hosts Kenyatta National Hospital, The Nairobi Hospital, Aga Khan University Hospital, Coptic Hospital and dozens of other major facilities, cementing its place as the country’s healthcare hub. 

Uasin Gishu County ranks second, with Ksh4.61 billion, driven almost entirely by Moi Teaching and Referral Hospital and several private Eldoret facilities. Kiambu follows with Ksh4.11 billion, reflecting its concentration of referral hospitals, including KUTRRH and AIC Kijabe Hospital, alongside numerous private institutions serving Nairobi’s metropolitan population. 

The next tier of counties tells a similar story: Kisumu (Ksh2.80 billion), Kisii (Ksh2.77 billion), Meru (Ksh2.74 billion) and Mombasa (Ksh2.68 billion). Nakuru, Nyeri and Machakos also feature among the top ten, while Bomet makes the list largely because of Tenwek Hospital’s exceptional contribution, showing how a single high-performing referral hospital can shape a county’s overall SHIF receipts. 

At the opposite end of the scale sits an entirely different reality. The smallest SHIF payments went to facilities offering mainly primary healthcare and outpatient consultations. 

Macmillan Hospital in Nairobi, Kichawa Health Centre in Homa Bay, Mwingi Medicare Centre in Kitui received Ksh2,240 each 

Macmillan Hospital in Nairobi, Kichawa Health Centre in Homa Bay and Mwingi Medicare Centre in Kitui each received just Ksh2,240 over the entire ten months. Danya Medical Centre in Nyamira received Ksh2,380, while St Gabriel Healthcare in Nairobi received Ksh2,550. 

The rest of the bottom ten, including Tuti Medical Clinic, Keringet Zion Hospital, Qasis Health Doctors Plaza, Equity Afia Kitale and various Bliss Healthcare branches, each received about Ksh3,000. Most are Level 2 and Level 3 facilities offering outpatient consultations, treatment for common illnesses and preventive services. Their low payments reflect the limited value and volume of claims generated under SHIF, not necessarily poor performance. 

A facility receiving Ksh2,240 over ten months averaged just Ksh224 a month, illustrating the enormous variation in reimbursement levels across Kenya’s healthcare system. 

County disparities are just as stark. Samburu recorded the lowest county payment nationally, at Ksh61.41 million, followed by Lamu (Ksh126.03 million) and Tana River (Ksh138.81 million). Isiolo and Marsabit complete the bottom five, with Ksh160.98 million and Ksh177.62 million respectively. 

Nairobi and Uasin Gishu draw thousands of referrals  due to advanced diagnostics, specialised clinicians 

The rest of the bottom ten, Tharaka-Nithi, Nyandarua, Murang’a, Taita-Taveta and Nandi, all received substantially less than counties hosting national referral hospitals. Most have few Level 5 and Level 6 facilities capable of managing the complex conditions that generate higher-value claims. 

Nairobi and Uasin Gishu certainly serve large populations, but they also draw thousands of referrals from neighbouring counties because they host advanced diagnostic equipment, specialised clinicians and high-level surgical services unavailable elsewhere. Patients often travel hundreds of kilometres to reach these facilities, meaning SHIF payments follow the patients rather than their counties of residence. 

Counties with advanced referral hospitals benefit from both higher patient volumes and costlier procedures that attract greater reimbursement. Counties without such facilities remain heavily dependent on primary healthcare, limiting the range of care they can offer and the SHIF revenue they can generate. 

The gap between the highest and lowest earners is stark. Moi Teaching and Referral Hospital’s Ksh1.70 billion payment was roughly 757,000 times greater than the Ksh2,240 received by Macmillan Hospital over the same period. Even the national median facility payment of Ksh627,500 represents less than one-thousandth of what the country’s leading hospitals received. 

Access to advanced surgery, cancer treatment, dialysis, neonatal intensive care and specialist diagnostics remains concentrated in relatively few counties, forcing many patients to travel long distances for treatment. 

As Kenya continues rolling out UHC through SHIF, this payment data offers a valuable snapshot of where healthcare capacity currently exists. 

Data visualisation by Stanley Njihia 

Text by Yvonne Kawira