The Social Health Authority has responded to questions about how it calculates health insurance contributions, following an investigative report by Africa Uncensored that highlighted differences in what households are being charged.
In its statement, SHA explained that it uses a system called the Means Testing Instrument to decide how much each household should pay.
The tool relies on an AI-based approach known as Proxy Means Testing, which looks at different indicators of living standards to estimate a household’s income, especially in the informal sector where earnings are not always documented.
The authority said this model is meant to create a fairer system compared to the former National Health Insurance Fund. According to SHA, the previous system placed a heavier burden on low-income earners, with some paying a larger share of their income than wealthier contributors.
It argued that the new approach aims to correct that imbalance by linking contributions more closely to estimated income levels.
Under the current structure, households are required to contribute 2.75 percent of their income, with a minimum monthly payment set at Ksh300.
SHA noted that more than half of formally employed members are now paying less than they did under the old system, which it sees as a sign of progress.
However, the report by Africa Uncensored raised concerns about how the tool works in practice.
It suggested that the system may have algorithmic bias, which could lead to poorer households being overcharged while wealthier ones pay less than they should.
The report also questioned the accuracy of the tool, pointing to possible errors in how poverty levels are assessed.
SHA has rejected these claims, saying the tool was developed with support from several institutions and has been tested using internal data.
It maintained that most households in the informal sector are paying Ksh850 or less each month.
The authority also dismissed allegations of fraudulent claims involving large sums of money, stating that there is no evidence to support those accusations.
