# NHIF to SHIF: What Kenyan Hospitals Need to Know > A clear breakdown of the move from NHIF to SHIF for Kenyan facilities, registration, contracting, claims differences, and the operational changes that matter. Source: https://www.afyaconnect.africa/resources/nhif-to-shif-transition-hospitals-kenya Last updated: 2026-06-26 Publisher: AfyaConnect HMS (Neurobyte Technologies), Nairobi, Kenya --- *Claims & Insurance · 6 min read · Updated 2026-06-26* A clear breakdown of the move from NHIF to SHIF for Kenyan facilities, registration, contracting, claims differences, and the operational changes that matter. The shift from NHIF to the Social Health Insurance Fund (SHIF), administered by the Social Health Authority (SHA), is the biggest change to Kenyan health financing in a generation. For hospital administrators the question is simple: what do I have to do differently to keep getting paid? Here is the practical version. ## NHIF, SHIF and SHA, who is who - **NHIF** was the old fund and administrator, now wound down. - **SHIF** is the new fund, where contributions go and reimbursements come from. - **SHA** is the authority that administers SHIF, contracts facilities, and adjudicates claims. When people say "we're on SHA now," they mean the whole new system: SHIF money, SHA rules. ## What changed for facilities ### 1. You must be contracted, not just registered Under NHIF, accreditation was the gate. Under SHA, your facility signs a contract that defines which services you can claim for. Treating patients for services outside your contract means those claims will not be paid. ### 2. Eligibility is checked up front SHA expects facilities to confirm a member is active before service. This pushes verification to the front desk and changes your registration workflow, reception now needs an instant active/inactive answer. ### 3. The benefit package is defined differently Services map to a structured benefit package. Your clinical and billing teams need to know what is covered at your facility level so they bill within it. ### 4. Claims are more structured Claims must carry proper diagnosis coding and provider details. Loose, free-text billing that sometimes slipped through under NHIF will now bounce. ## A practical transition checklist - [ ] Confirm your facility's SHA contract and the services it covers - [ ] Update front-desk workflow to verify member eligibility before service - [ ] Train clinicians to record ICD-coded diagnoses for every encounter - [ ] Make sure provider registration numbers are captured on every claim - [ ] Set a daily routine for reviewing rejected claims - [ ] Reconcile SHA payments against billed amounts every cycle ## Where hospitals lose money in the transition The losses are rarely dramatic, they are slow leaks: members treated while inactive, claims rejected for coding and never resubmitted, services rendered outside the contracted package. Each one is small; together they can be a meaningful share of monthly revenue. ## How software closes the gaps A system built for SHA removes the manual steps where revenue leaks. AfyaConnect verifies eligibility at registration, captures coded encounters from the clinician, generates SHA-formatted claims from that record, and tracks every claim to approval or rejection. Your team spends its time on the handful of claims that need attention instead of re-keying the ones that don't. Moving to SHA is a good moment to also move off paper and spreadsheets. [Register your hospital](/hospital-signup) to see the full claims workflow, or [explore the features](/features) first. --- **Author:** The AfyaConnect Clinical & Product Team — Health systems and product engineering, Neurobyte Technologies The team that builds and supports AfyaConnect writes these guides. Everything here is written against software we actually ship and support in live Kenyan facilities — the SHA claims flow, the PPB controlled substances register and the eTIMS invoicing described in these guides are modules we maintain, not features we read about. Where regulation is still moving, we say so rather than guessing. - Supports 40+ healthcare facilities across Kenya and East Africa - Builds and maintains the SHA/NHIF claims, PPB register and KRA eTIMS modules described in these guides - Works to the Kenya Data Protection Act 2019 and Digital Health Act 2023 requirements for patient data Last reviewed: 2026-06-26