But Judgment faults government over rushed transition of SHIF, orders structural reforms under court supervision to fix access failures and transparency gaps.
The High Court has declared Kenya’s Social Health Insurance Fund (SHIF) legally sound but ruled that its chaotic launch denied millions of Kenyans access to healthcare, violating their constitutional rights.
Delivering judgment at the Milimani High Court in Nairobi on 19 March 2026, Justice Bahati Mwamuye found that the legal framework establishing SHIF is constitutional and valid. Regulations guiding the system were properly developed, subjected to public participation, and not annulled by the Senate.
The court also upheld key funds under the Social Health Insurance Act, including the Primary Healthcare Fund and the Emergency, Chronic and Critical Illness Fund.
However, the court found that rolling out the system on 1 October 2024, before the necessary administrative and technological systems were in place, fell short of the constitutional standard of reasonableness. Many Kenyans were unable to access essential and life-saving healthcare services in the early stages, violating their rights to health and human dignity.
“Although the legal framework is valid, the manner in which the system was initially implemented fell short of the standard of reasonableness required by the Constitution,” Justice Mwamuye stated.
Nullifying the system would profoundly disrupt the health sector and jeopardise Universal Health Coverage
SHIF replaced the former National Hospital Insurance Fund (NHIF) as the central pillar of Kenya’s Universal Health Coverage (UHC) plan, managed by the Social Health Authority (SHA).
The case, filed by Busia Senator Okiya Omtatah and others, also challenged the award of a Ksh104.8 billion digital health contract to a Safaricom-led consortium for the Integrated Healthcare Information Technology System (IHITS), SHIF’s digital backbone.
While the court accepted the use of special procurement due to urgency, it faulted the process for lacking full transparency and proper documentation. It nonetheless declined to cancel the contract, noting that by early 2025, more than 18.7 million people had been onboarded and claims processing had stabilised.
SHA must submit an action plan within 90 days to ensure no person is denied emergency treatment
“Nullifying or invalidating the system would profoundly disrupt the health sector and jeopardise the State’s effort to achieve Universal Health Coverage,” the court observed.
Instead, the court issued a structural interdict, placing implementation under judicial supervision. The Ministry of Health, State Department for Medical Services, and SHA must, within 90 days, submit an action plan to ensure no person is denied emergency treatment, implement fair contribution systems for informal workers, strengthen procurement transparency, and establish a clear public complaints system. Quarterly progress reports will be required for one year.
For ordinary Kenyans, the decision offers hope that access to healthcare will improve while putting pressure on the government to resolve ongoing challenges around fairness and service delivery.
