Constitutional lawyer Willis Otieno has come out guns blazing to challenge the William Ruto-led government over a demand that any Kenyan wishing to be covered by the Social Health Authority (SHA) must pay for a full year’s package upfront.
Through his X handle on Tuesday, August 5, 2025, Otieno said that the government’s insistence on an annual lump sum payment is out of touch with the realities of ordinary Kenyans.
He argued that most people in the country earn irregular incomes, especially those in the informal sector, and forcing them to produce KSh 6,000 at once, or more for those with families, will shut millions out of healthcare.
“Why does the government demand full-year SHA payment upfront?
“In a country where most people are on informal or inconsistent incomes, demanding an upfront payment of KSh 6,000 (or more for families) is not only tone-deaf, it’s exclusionary,” Otieno wrote on X.
Health CS Aden Duale during a past media presser. Photo: Aden Duale Source: Facebook
Otieno went on to paint a bleak picture of what this requirement means for low-income earners. “A worker earning KSh 10,000 a month is expected to cough up nearly three-quarters of their salary just to register before they ever see a doctor,” he said, adding that such a policy effectively locks out the very people the health plan is supposed to protect.
He emphasised that progressive health financing should adapt to Kenyans’ diverse economic realities. According to Otieno, a fair system would allow monthly or flexible contributions pegged on income levels, rather than a blanket annual fee that ignores the plight of millions living from hand to mouth.
Otieno’s remarks come amid growing criticism of the rollout of the SHA, with many Kenyans voicing concerns that the new system is being implemented without adequate consultation with the very citizens it aims to serve.
“This kills the very spirit of progressive health financing, which should be flexible, income-sensitive, and protective of the vulnerable,” Otieno concluded.
The SHA, launched late last year as a replacement for NHIF, is meant to offer universal health coverage. But the annual payment requirement has become a lightning rod for criticism, with many fearing it could end up worsening inequality in access to essential health services.
