The National Assembly Health Committee, chaired by Hon. Dr. James Nyikal, convened a critical session in Mombasa with the Social Health Authority (SHA) leadership, CEO Dr. Mercy Mwangangi, Private Healthcare providers and the Kenya Private Sector Alliance (KEPSA) Health Sector, as part of the 8th Speaker’s Roundtable (SRT).

The meeting focused on the operational and financial hurdles facing the SHA, particularly concerning provider payments and claims processing.

Hon. Dr. Nyikal underscored the commitment of the committee to the SHA's operationalisation, stating it represents the "most important financial restructuring of the health sector."

The private health providers highlighted the claims process as their biggest challenge, noting risks of being suspended for 90 days on fraud accusations before being heard.

A proposal was tabled to introduce financial penalties, similar to the banking and insurance sectors, for financial improprieties, replacing immediate suspension.

SHA CEO Dr. Mercy Mwangangi provided a financial snapshot, confirming that the Social Health Insurance Fund (SHIF) has collected Kshs 81 billion since its inception in October 2024 up to November 2025.

According to the SHA CEO, approximately 3.6 million Kenyans in the formal sector and nearly one million in the informal sector are currently captured in the SHA system. Additionally, SHA has covered 500,000 poor households via funding from the Social Protection Fund.

Participants noted that SHA currently owes healthcare providers Kshs 30 billion in pending bills, inherited from the National Health Insurance Fund (NHIF).

Members of the Health Committee raised several issues requiring immediate attention including informal sector contributions, Prof. Waqo Jaldesa noted the disparity in contribution requirements, where the self-employed are currently "being forced to make lump sum contributions of 4 months up to a year," unlike the monthly contributions of the formally employed.

Speaking on hospital onboarding, Hon. Joshua Oron questioned the readiness of regulatory bodies. He pointed to the Kenya Medical Practitioners and Dentists Council (KMPDC) and Counties are facing hurdles in onboarding of hospitals questioning KMPDC’s capacity for inspection and facility onboarding. “Does KMPDC have the capacity to do inspections and on board health care facilities for licensing and registration to SHA. We need to ” he stated.

Hon. Mary Maingi stressed the need to increase collection points and develop a viable strategy for netting more Kenyans, arguing that current funding is "not sustainable." She further emphasised the importance of quickly clearing the inherited NHIF pending bills.

To boost enrolment and expedite claim processing, the Authority, which currently has 815 employees, plans to introduce an agency model to net informal sector players like those in KTDA. The goal is to increase claims processing speed to a monthly cycle.

Hon. Julius Sunkuli urged the private Healthcare providers and SHA reps to introduce legislation to seal legal loopholes to enhance the SHA impelemenation while Hon. Robert Pukose attested to operational challenges identified during hospital visits across the country.

The session with an agreement to develop clear proposals, including necessary legislative amendments, to address the bottlenecks raised, with the expectation of crafting an evidence-based advocacy roadmap for parliamentary approval.

Committee Chair Hon. James Nyikal concluded the session by calling for a "Cost of Care Bill" to be formulated by the sector to help manage healthcare costs nationally. He urged the private sector to bring forward robust policy proposals for parliamentary action.