Dozens of women lining up for family planning services at the Matungu Level 4 Hospital in Kakamega County are being turned away daily due to the new requirement mandating Social Health Authority (SHA) registration, a development that has alarmed both healthcare providers and community members.

Family planning services providers such as Truphena Nyaboke are profoundly worried about this fact.

According to Nyaboke, the facility’s family planning service provider, the introduction of SHA as a prerequisite for accessing care has drastically reduced the number of clients visiting the family planning clinic.

She noted that in previous months, she would attend to at least 15 clients a day. However, since the new regulation came into effect, that number has dwindled sharply.

“Now, women are being stopped right at the registration desk if they do not have an SHA number. Many of them cannot afford the registration fee because of poverty, and they end up going back home,” Nyaboke told me during a visit to the facility.

“We used to offer these services free of charge. Why make SHA mandatory now?”

The SHA system was introduced to streamline access to healthcare and improve record-keeping and requires users to register and pay an annual subscription fee.

For many in rural areas like Matungu, this cost, though considered minimal by authorities, is a significant barrier.

Reversing gains made in reproductive health

Health rights activists and local leaders have expressed concern over the policy, warning that it risks reversing gains made in reproductive health and family planning uptake in underserved areas.

In 2025, the Kenyan government, through the Ministry of Health, gazetted a comprehensive Social Health Insurance Fund (SHIF) benefits package aimed at improving universal health coverage.

Legal Notice No. 56, under the Social Health Insurance Act No. 16 of 2023, outlines detailed tariffs and services available to all registered beneficiaries.

Under the Primary Healthcare Fund, every Kenyan enrolled in a Primary Care Network (PCN) can access outpatient services—including consultation, diagnostics, treatment of chronic and communicable diseases, mental health support, immunization, and maternal-child care—for Sh900 per person annually.

Unfair and discriminatory

Yet some health providers are concerned, describing SHA as discriminatory.

“Forcing SHA registration on essential services like family planning, which have always been free, is unfair and discriminatory,” said a local community health volunteer who requested anonymity.

“These women are already vulnerable. This new requirement only pushes them further away from care.”

Truphena echoed the same sentiments, noting that reluctance to sign up for SHA is growing, with many residents skeptical of the system or simply unable to pay the subscription fee.

“They are becoming reluctant to even try. They say, ‘Why should I register if I only come once a year for an implant or injection?’” she explained.

Family planning services are a critical component of primary healthcare, especially for women in low-income settings. The reduction in access could have far-reaching consequences, including an increase in unplanned pregnancies and strain on maternal health services.

SHIF covers services at Level 4 to 6 hospitals. This includes inpatient services with tariffs ranging from Sh2,240 to Sh4,480 per day depending on hospital level, capped at 180 days per household per year.

Maternity care is also covered, with Sh10,000 allocated for normal delivery and Sh30,000 for caesarean sections, inclusive of newborn care and diagnostics.

Difficult choices for women

Meanwhile, women like those in Matungu continue to face difficult choices—pay for SHA subscription or forego vital reproductive health services.

When Lydia, a night guard and mother of four from Mumias Town, made the trip to Matungu Level 4 Hospital, all she wanted was a contraceptive implant—a simple procedure that could help her take control of her future.

Instead, she was sent home.

“I was told I couldn’t get any services if I hadn’t registered for SHA,” Lydia recalls, referring to the  (SHA) system recently introduced in Kakamega County.

“I didn’t even know I needed it. I thought family planning was still free.”

The SHA program, intended to streamline healthcare access through digital registration, has become an unexpected barrier for women like her.

To access any medical service at the facility—including family planning—patients now must present an SHA number. Without it, they're turned away.

Lydia hadn’t registered. She also didn’t have the money to do so.

“I haven’t gone back,” she says. “I don’t have the subscription or registration fee—if there is one. Right now, I can’t afford anything extra.”

For Lydia, family planning isn’t just a medical decision—it’s about survival.

She works long, exhausting night shifts as a security guard, then spends her days caring for her children.

Another pregnancy, she says, would be devastating if not a crushing blow.

“If I get pregnant again, I won’t be able to work. I’ll have to stay at home with the baby. But then who will provide for us?”

Her voice breaks and tightens as she speaks about her domestic situation.

Her husband, she explains, is a habitual drunkard and contributes nothing to the household.

“It’s all on me. Feeding, school fees, clothes—everything. And I’m already struggling.”

What makes Lydia’s case even more heartbreaking is that family planning services like the implant she was seeking have always been provided free of charge in public facilities.

For years, women like her have accessed contraception without needing anything more than a national ID.

Now, the requirement to register for SHA—a system many residents do not fully understand and cannot easily afford—is deterring the most vulnerable from seeking care.

“I feel like I’m being punished for being poor,” says Lydia.

As she speaks, it’s clear that her concern is not just about herself, but for many other women in similar situations—women who want to take charge of their health, but are now shut out of the system.

Lipa SHA Pole Pole, a game changer

To address such concerns, the government unveiled the Lipa SHA Pole Pole, an initiative that allows individuals, particularly those in the informal sector, to pay for their Social Health Authority (SHA) insurance contributions in flexible, affordable installments, rather than in a lump sum.

President William Ruto officially unveiled the initiative during the 62nd Madaraka Day celebrations on June 1, 2025.

The initiative aims to address the financial barriers faced by millions in the informal economy, which accounts for over 80% of the nation’s workforce, according to the president.

According to the Social Health Authority CEO, Dr. Mercy Mwangangi, Lipa SHA Pole Pole is as a game-changer.

It allows non-salaried Kenyans to pay their yearly SHA contributions in smaller, flexible instalments on a daily, weekly, or monthly basis, depending on their earning frequency.

Dr. Mwangangi emphasized the importance of helping ordinary Kenyans understand how SHA contributions improve healthcare services.

“We must show Kenyans exactly how their contributions to SHA translate into improved health services,” Dr. Mwangangi said when she took over at the Authority’s helm in June 2025.

“This includes sharing a comprehensive performance report that details the health outcomes we are pursuing.”

A key focus area, she noted, is strengthening primary healthcare services, including maternal healthcare.

When I put the concerns of women like Lydia to Dr. Mwangangi, she responded emphatically:  “No primary healthcare facility should charge for it. Registration for SHA is also free. I don't understand why the facility turned away the patient.”

For women such as Lydia, however, it’s time to shelve plans to sire more children.

“I don’t want to have another child I can’t take care of. But what choice do I have now?” Lydia concludes.