What SHA pays Kenyan facilities for common care

What Kenya's Social Health Authority lists for primary care, inpatient days and maternity, and how a facility records the amounts SHA owes it.

By Achekam · 11 October 2026 · 5 min read · For Healthcare businesses in Kenya

For many Kenyan clinics, health centres and hospitals, the Social Health Authority (SHA) is now the single largest payer. That makes its tariffs the most important price list the facility has, even though the facility did not set it. Knowing what SHA pays for a primary care visit, an inpatient day or a delivery decides whether a service covers its costs, and knowing how much SHA owes at any moment decides whether the facility can pay its staff at month end.

This article summarises the main tariffs SHA lists for common care at the time of writing, explains the way primary care is paid, and shows how a facility can treat SHA as a customer in its books so that nothing it is owed goes untracked. The tariffs change, so check SHA's own page before relying on any figure.

The three funds

SHA runs three health funds:

• the Primary Healthcare Fund (PHF);
• the Social Health Insurance Fund (SHIF);
• the Emergency, Chronic & Critical Illness Fund (ECCIF).

Which fund pays depends on the service. As the names suggest, primary care sits with the PHF and emergency, chronic and critical illness care with the ECCIF, while SHA lists its medical inpatient tariff under SHIF. For a facility, the practical point is that claims are not all handled the same way, and the money arrives on different bases.

Primary care: capitation, not a fee per visit

SHA's tariff for primary healthcare outpatient services at Level 2, 3 and select Level 4 facilities is KES 900 per person per annum. SHA says it is allocated as a global budget capitation by Primary Care Network population and distributed at month end based on patient visits weighted by the disease treated. All registered beneficiaries are mapped to a Primary Care Network at registration.

In plain terms, the facility is not paid a fixed amount for each consultation. A pool of money is set for the network's registered population, and each month it is shared out according to the visits facilities record, weighted by what was treated. Two consequences follow:

• Recording visits accurately matters. The share that reaches your facility depends on the visits and conditions you record.
• The income does not match individual invoices. Agree with your accountant how to record each month's capitation when SHA confirms it, usually as its own income line rather than against individual patients.

Inpatient rates by level

SHA lists its SHIF medical inpatient tariff by facility level at the time of writing:

SHA lists a limit of up to 180 days per household per annum. A household with several admissions in a year shares that limit, so a long stay for one member reduces what is left for the others. Before admitting a patient for a planned stay, it is worth knowing how much of the household's limit has already been used.

Maternity, and emergency care for everyone

SHA's maternity tariffs are KES 10,000 for a normal delivery with essential newborn care, and KES 30,000 for a caesarean section with essential newborn care.

SHA also says its accident and emergency cover is accessible to all Kenyan residents irrespective of registration or premium payment status, for care of up to a maximum of 24 hours. After that, SHIF benefits are activated for paid-up members. A facility therefore treats an emergency first and checks status afterwards, but should check before the 24 hours run out, because what happens next depends on whether the patient is a paid-up member.

The SHA benefit tariffs page lists every package with its tariff, limits and conditions, and is the reference to keep open when setting up your price list.

SHA as a customer in the books

However SHA pays, the facility's books should show what SHA owes at any moment, just as they would for a medical scheme or a corporate client. On Achekam:

• One customer for SHA. Set SHA up as a customer, and raise customer invoices for the claims you submit. Invoices start as drafts that can be changed or deleted, which suits a claim still being checked; issuing one takes the next number in its sequence and posts it to the ledger.
• Part payments. SHA may pay a batch of claims in one remittance, or pay less than claimed. A business records payments against one invoice or spread across a customer's invoices; a part payment leaves the invoice part-paid, and any extra is held on the customer's account. A receipt can be re-allocated if it was matched to the wrong claim.
• What is overdue. Receivables are aged into 0-30, 31-60, 61-90, 91-120 and over 120 days, with overdue totals. Watching SHA's balance move through those bands shows how quickly claims are really being paid, which is the figure that matters for cash flow.

Where SHA pays only part and the rest falls to the patient, the process is similar to collecting a shortfall after a medical scheme, covered in collecting the balance after medical aid pays part. Patients who settle their share at the front desk often pay by mobile money; see taking M-Pesa at a Kenyan practice's reception.

Tax codes on Kenyan invoice lines

A Kenyan business on Achekam picks a tax code on each invoice line: standard, zero-rated, exempt, out of scope or reverse charge. Only standard lines carry VAT, at the approved rate for Kenya, and the codes apply once the Kenya pack is activated under Settings, Jurisdiction & regulators. Agree with your tax adviser which code applies to each type of service you bill to SHA and to patients, and set it consistently.

Before month end

Compare SHA's balance in your aged receivables with the claims you have submitted and the remittances received. Chase the oldest unpaid claims first, and record each month's capitation once SHA confirms it. A facility that knows exactly what SHA owes can plan around it; one that does not finds out when the bank balance runs short.

General guidance only, not advice on your own circumstances. Tax and payroll rules change: check the current position with the authority or your adviser.