The Social Health Authority (SHA) disbursed Ksh12.57 billion to 7,282 health facilities across 45 counties between July 2025 and January 2026, but the payments reached only 49 per cent of Kenya’s 14,883 facilities.  

More than half the country’s health infrastructure sits entirely outside the SHA payment system, neither contracted nor compensated. Where the model has the conditions to operate, it has delivered a measurable redistribution toward lower-level facilities. Where those conditions are absent, it produces outcomes that mirror, and sometimes amplify, the inequities it was designed to correct. 

The SHA data reveals a system whose structural design is sound but whose reach remains sharply constrained by geography, digital infrastructure, and administrative capacity. Counties with higher SHA registration and stronger digital systems dominate the funding table, while marginalised counties receive a fraction of disbursements despite carrying significant care burdens. The gap is visible at every level, from county totals to individual facility averages. 

The geographic distribution is such that Nairobi received Ksh1.34 billion across 347 facilities, more than ten times Tana River’s Ksh41.5 million across 48 facilities. Kiambu (Ksh650 million) and Mombasa (Ksh584 million) followed, meaning these three counties alone absorbed roughly Ksh2.57 billion, just over 20 per cent of the total national disbursement. Nakuru and Kakamega followed at Ksh555 million and Ksh545 million, respectively. At the other end, Samburu received Ksh49.6 million and Lamu Ksh56.3 million. 

The model has achieved a genuine structural shift in how money flows between facility levels 

At the facility level, the gaps are starker. A Mombasa facility received on average Ksh5.3 million, more than thirteen times the Ksh398,000 average for Mandera’s 317 contracted facilities, the lowest in the country. Nairobi’s facilities averaged Ksh3.86 million, Kiambu’s around Ksh2.2 million, and Samburu’s 64 facilities averaged Ksh775,000. Samburu’s combined receipts represent less than 1.2 per cent of total national disbursements. 

The model has nonetheless achieved a genuine structural shift in how money flows between facility levels. Under the defunct National Hospital Insurance Fund (NHIF), Level 4 hospitals absorbed the dominant share of capitation funding despite dispensaries and health centres delivering the majority of actual primary care contacts. 

SHA’s disease-weighted model has inverted this: Level 2 dispensaries now capture 43.5 per cent of disbursements, Level 3 health centres 37.4 per cent, and Level 4 hospitals just 19.1 per cent. Magongo MCM Dispensary in Mombasa illustrates what this can mean in practice. It received Ksh32.7 million, ranking seventh nationally and outpacing numerous sub-county hospitals. 

The limits of the model are visible in the same data. Roughly 7,600 facilities remain outside the SHA primary healthcare system. Some are private clinics that have opted out or specialised facilities outside the PHC package scope. But a significant portion are almost certainly dispensaries and health centres in marginalised counties that lack the registration, digital systems, or administrative capacity to be onboarded. A further 278 contracted facilities received less than Ksh10,000 for the full seven months, and the density of contracted facilities in central Kenya and the western corridor makes the absence of the rest all the more visible. 

Data visualisation by Stanley Njihia & Text by Yvonne Kawira.